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UBC Theses and Dissertations

An evaluation of the role, theory, and practice of the occupation of homemaker Auman, Jane Tate 1981

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AN EVALUATION OF THE ROLE, THEORY, AND PRACTICE OF THE OCCUPATION OF HOMEMAKER by JANE[TATE AUMAN B.A., The U n i v e r s i t y of B r i t i s h Columbia, 1974 A THESIS SUBMITTED IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF ARTS i n .THE FACULTY OF GRADUATE STUDIES Department of C u r r i c u l u m and I n s t r u c t i o n a l S t u d i e s We a c c e p t t h i s t h e s i s as c o n f o r m i n g t o the r e q u i r e d s t a n d a r d THE UNIVERSITY OF BRITISH COLUMBIA Oc t o b e r , 1981 (5) Jane Tate Auman, 1981 I n p r e s e n t i n g t h i s t h e s i s i n p a r t i a l f u l f i l m e n t o f t h e r e q u i r e m e n t s f o r an advanced degree a t the U n i v e r s i t y o f B r i t i s h C o l u m b i a , I ag r e e t h a t t h e L i b r a r y s h a l l make i t f r e e l y a v a i l a b l e f o r r e f e r e n c e and s t u d y . I f u r t h e r agree t h a t p e r m i s s i o n f o r e x t e n s i v e c o p y i n g o f t h i s t h e s i s f o r s c h o l a r l y p u r p o s e s may be g r a n t e d by t h e head o f my department o r by h i s o r h e r r e p r e s e n t a t i v e s . I t i s u n d e r s t o o d t h a t c o p y i n g o r p u b l i c a t i o n o f t h i s t h e s i s f o r f i n a n c i a l g a i n s h a l l n o t be a l l o w e d w i t h o u t my w r i t t e n p e r m i s s i o n . Department o f h—' The U n i v e r s i t y o f B r i t i s h C o l u m b i a 2075 Wesbrook P l a c e Vancouver, Canada V6T 1W5 DK-fi (7/7Q) ABSTRACT A homemaker i s an i n d i v i d u a l who i s employed by a homemaking agency f o r the purpose of p r o v i d i n g in-home s e r v i c e t o s p e c i f i c c l i e n t s . These c l i e n t s e r v i c e s i n v o l v e housekeeping and/or p e r s o n a l c a r e a s s i s t a n c e . U n t i l now l i t t l e r e s e a r c h has been done i n the ar e a of homemaking as an o c c u p a t i o n . T h e r e f o r e , t h i s study i s i n t e n d e d t o p r o v i d e r e s e a r c h background f o r p r e s e n t and f u t u r e work c o n c e r n i n g the homemakers i n the a r e a s of t h e i r r o l e change, t h e o r y , and p r a c t i c e . U s i n g the dat a base o b t a i n e d from s u p e r v i s o r case notes of homemaker c l i e n t s i n the y e a r s 1976 and 1980, t h i s s tudy attempted t o lo o k a t the r o l e changes t h a t o c c u r r e d and the d i s c r e p a n c y t h a t e x i s t e d between the p r a c t i c e of homemakers i n an agency and the p r a c t i c e i t s homemakers were taught w i t h i n the c l a s s r o o m . The sample d a t a was d e r i v e d from one hundred c l i e n t f i l e s each from 1976 and from 1980. The i n d i v i d u a l f i l e s were randomly s e l e c t e d from the f i l e s of a l a r g e m e t r o p o l i t a n homemaker agency w i t h i n the p r o v i n c e of B r i t i s h Columbia. The c o r r e s p o n d i n g c u r r i c u l u m t h a t was used i n t h i s s t u d y i s the Homemaker Program of the Vancouver Community C o l l e g e , Vancouver, B.C., as taught i n 1980. Methodology f o r t h i s r e s e a r c h i n c l u d e d s t a t i s t i c a l a n a l y s e s of the c l i e n t f i l e data-and use of the Provus D i s c r e p a n c y E v a l u a t i o n Model, i n which the a c t u a l p r a c t i c e of the homemaker and the f o r m a l c u r r i c u l u m of homemaker t r a i n i n g were compared. F i n d i n g s of the r e s e a r c h a r e t h a t the c l i e n t of 1980 appeared t o be o l d e r , was r e p r e s e n t a t i v e of a n u m e r i c a l l y s m a l l e r h o u s e h o l d , and depended on o t h e r s f o r r e f e r r a l t o the homemaker agency. C r o s s - t a b u l a t i o n s of the y e a r s (1976 and 1980) w i t h a v a r i e t y of h e a l t h and demographic i n d i c a t o r s d i s p l a y s t a t i s t i c a l l y s i g n i f i c a n t i n c r e a s e i n 1980 of c l i e n t s who had p s y c h o l o g i c a l and m e d i c a l - s u r g i c a l problems. However, c h i l d - c a r e r e l a t e d problems f o r these c l i e n t s d e c r e a s e d s i g n i f i c a n t l y i n 1980. The c a t e g o r y of homemaker p r a c t i c e , meaning the d u t i e s t h a t the homemaker was i n d i c a t e d as h a v i n g been r e q u i r e d t o perfo r m i n the c l i e n t ' s home, a l s o showed a r e a s of s i g n i f i c a n t s t a t i s t i c a l change. C r o s s - t a b u l a t i o n s of these y e a r s i n d i c a t e t h a t p e r s o n a l c a r e and housekeeping p r a c t i c e had i n c r e a s e d s i g n i f i c a n t l y by 1980. Homemaker p r a c t i c e r e l a t e d t o a s s i s t a n c e w i t h c h i l d c a r e i n the home de c r e a s e d i n 1980. A d i s c r e p a n c y a n a l y s i s between the p r a c t i c e of the homemaker i n the c l i e n t ' s home and t h e i r c o r r e s p o n d i n g c u r r i c u l u m of the homemaker t r a i n i n g program i n d i c a t e d congruency f o r e i g h t of the e l e v e n p r a c t i c e c a t e g o r i e s . The ar e a s of d i s c r e p a n c y were: 1) r e p l a c e Home Care nurse ( t e m p o r a r i l y ) ; 2) a s s i s t w i t h the a d m i n i s t r a t i o n of m e d i c a t i o n s ; and 3) mo n i t o r s t a t e of h e a l t h . The homemaker o r g a n i z a t i o n i s a s e r v i c e o r i e n t e d group i n which r a p i d r o l e changes a r e o c c u r r i n g , accompanied by the ev i d e n c e of some apparent d i s c r e p a n c i e s between c u r r i c u l a r t h e o r y and. a c t u a l p r a c t i c e . i v TABLE OF CONTENTS A b s t r a c t i i L i s t of T a b l e s v Acknowledgement v i Chapter I PROBLEM AREA ... . 1 Chapter I I LITERATURE REVIEW 10 Chapter I I I CONCEPTUAL FRAMEWORK 15 Chapter IV METHODOLOGY 19 Chapter V RESULTS 27 Chapter VI DISCUSSION AND RECOMENDATIONS . 67 Re f e r e n c e s 79 Appendix 82 LIST OF TABLES T a b l e . I 30 T a b l e I I 31 T a b l e I I I 32 T a b l e IV . 33 Table V . . . 36 T a b l e VI 37 T a b l e V I I 38 T a b l e V I I I 39 T a b l e IX . . 40 Table X 41 T a b l e XI . 42 T a b l e X I I 50-ACKNOWLEDGEMENT S p e c i a l thanks a re g i v e n t o my t h e s i s a d v i s o r , Dr. Robert Conry, f o r h i s i n i t i a l i n t e r e s t and c o n t i n u e d support of my t h e s i s . I would a l s o l i k e t o acknowledge the generous a s s i s t a n c e t h a t I r e c e i v e d from the homemaker agency i n which the r e s e a r c h was conducted. T h i s t h e s i s i s d e d i c a t e d t o my p a r e n t s , W a l t e r and Vongue Ta t e . 1 Chapter I  PROBLEM AREA I n t r o d u c t i o n S o c i e t a l u n d e r s t a n d i n g s about h e a l t h and h e a l t h s e r v i c e s have undergone r a d i c a l changes w i t h i n the p a s t one hundred y e a r s . P r i o r t o the n i n e t e e n t h c e n t u r y , the s t a t e of h e a l t h and tr e a t m e n t of d i s e a s e was v e r y much person o r i e n t e d . The s i c k were u s u a l l y c a r e d f o r i n t h e i r homes, a t t e n d e d by f a m i l y and community members. S i c k n e s s , a g i n g , and de a t h were commonly e x p e r i e n c e d phenomena t h a t o c c u r r e d w i t h i n the l i f e s p a n of i n d i v i d u a l s ; and as such were u n d e r s t o o d as b e i n g a s p e c t s of l i f e over which the i n d i v i d u a l had l i t t l e or no c o n t r o l . The advent of the germ t h e o r y i n the n i n e t e e n t h c e n t u r y c r e a t e d a d r a m a t i c change i n the b e l i e f s t r u c t u r e s c o n c e r n i n g h e a l t h and d i s e a s e . What o c c u r r e d was a r e f o c u s i n g of a t t i t u d e s onto the d i s e a s e p r o c e s s and away from the i n d i v i d u a l . There was a d i m i n i s h i n g i n t e r e s t by the m e d i c a l p r o f e s s i o n i n the non-b i o l o g i c a l a s p e c t s of i l l n e s s . As p r o f e s s i o n a l s w i t h i n h e a l t h s e r v i c e s e t t i n g s became more s k i l l e d and i n s t i t u t i o n a l l y o r i e n t e d , the power and mystique s u r r o u n d i n g t h e h e l p e r i n c r e a s e d . A p r o f e s s i o n a l body of knowledge t h a t encompassed the cause, e f f e c t , and t r e a t m e n t of the i n f i r m e d was d e v e l o p e d . S p e c i a l i z a t i o n s w i t h i n the f i e l d of the h e l p i n g p r o f e s s i o n s i n c r e a s e d . The knowledge about the a r e a of h e a l t h c a r e and s o c i a l s e r v i c e a s s i s t a n c e became more complex 2 as the demand f o r these s e r v i c e s i n c r e a s e d . More r e c e n t l y , h e a l t h s e r v i c e s t r u c t u r e s have begun t o show a d d i t i o n a l s i g n s of change. I n t e r e s t has i n c r e a s e d i n the concept of t r e a t i n g the whole person as w e l l as the d i s e a s e p r o c e s s . A l t e r n a t i v e c h o i c e s f o r the c a r e of the e l d e r l y , the c h r o n i c a l l y i l l , and the dependent i n d i v i d u a l have appeared. B o a r d i n g homes, r e s i d e n t i a l c a r e f a c i l i t i e s , h e a l t h c a r e o r i e n t e d apartment complexes have i n many ca s e s r e p l a c e d and supplemented the asylums, orphanages, and l a r g e h o s p i t a l complexes of the p a s t . T h i s may be due t o the r e a l i z a t i o n t h a t l o n g term, i n s t i t u t i o n a l l y . b a s e d c a r e i s not o p t i m a l c a r e f o r c e r t a i n c l i e n t s and the b e l i e f t h a t home or community s i t u a t e d c a r e may be more c o s t b e n e f i c i a l t o the t a x p a y e r . The homemaker o r g a n i z a t i o n i s a s o c i a l s e r v i c e , h e a l t h c a r e o r i e n t e d a s s o c i a t i o n t h a t was c r e a t e d w i t h i n the p r o f e s s i o n a l mode of c l i e n t a s s i s t a n c e i n the e a r l y n i n e t e e n - h u n d r e d s . I t i s a s e r v i c e t h a t has r a p i d l y i n c r e a s e d i n response t o the demand f o r a l t e r n a t i v e modes.of a s s i s t a n c e f o r the e l d e r l y , the c h r o n i c a l l y i l l , and the dependent i n d i v i d u a l . Homemakers have c o n s i s t e n t l y , s i n c e t h e i r b e g i n n i n g s as an o c c u p a t i o n a l group i n the n i n e t e e n t h i r t i e s , p r o v i d e d s e r v i c e t o the c l i e n t i n the a r e a s of housekeeping and p e r s o n a l c a r e a s s i s t a n c e . However, as the s h i f t toward the a l t e r n a t i v e c h o i c e of home and community based s e t t i n g s f o r c e r t a i n i n d i v i d u a l s has i n c r e a s e d , the r o l e and p r a c t i c e of the homemaker appears t o have changed. There have been few s t u d i e s p u b l i s h e d t h a t a r e r e l a t e d t o the homemaker. T h e r e f o r e , the w r i t e r attempted t o c r e a t e a st u d y of the homemaker t h a t i s b o t h q u a n t i t a t i v e and q u a l i t a t i v e 3 i n n a t u r e i n o r d e r t o p r o v i d e a m u l t i p l e p e r s p e c t i v e of t h i s unique o c c u p a t i o n . S p e c i f i c a l l y the study l o o k e d a t the degree of congruency or d i s c r e p a n c y t h a t e x i s t s between the t h e o r y (the f o r m a l c u r r i c u l u m t h a t i s taught t o the homemaker) and the a c t u a l p r a c t i c e of the homemaker i n the home of the c l i e n t . The study a l s o i n v o l v e d a l i m i t e d a n a l y s i s of the r o l e change of the homemaker i n B r i t i s h Columbia s i n c e the n i n e t e e n t h i r t i e s w i t h a p a r t i c u l a r f o c u s on the changes t h a t appear t o have o c c u r r e d between 1976 and 1980. H i s t o r y of the Homemaker O r g a n i z a t i o n Berger and Luckman (1966) contend t h a t an i n s t i t u t i o n cannot be a d e q u a t e l y u n d e r s t o o d u n l e s s t h e r e i s an u n d e r s t a n d i n g of the h i s t o r i c a l p r o c e s s i n which i t was produced. Our contemporary u n d e r s t a n d i n g of the homemaker i s t h e r e f o r e grounded w i t h i n the changes t h a t have occurred- i n h e a l t h and s o c i a l s e r v i c e a s s i s t a n c e of the p a s t c e n t u r y , as w e l l as the more s p e c i f i c and r e g i o n a l l y d e f i n e d changes of the pa s t f i v e y e a r s w i t h i n the p r o v i n c e of B r i t i s h C olumbia. H i s t o r i c a l , documentary a c c o u n t s of the o r i g i n s and development of the homemakers o r g a n i z a t i o n w i t h i n B r i t i s h Columbia e x i s t i n a l i m i t e d form t h a t i s not e a s i l y r e s e a r c h a b l e . There are few p u b l i s h e d a r t i c l e s or u n p u b l i s h e d s t u d i e s r e l a t e d t o homemakers. The h i s t o r i c a l i n f o r m a t i o n t h a t does e x i s t i s u s u a l l y found i n the form of p r i m a r y or secondary s o u r c e s , w i t h the m a j o r i t y of documents b e i n g s i t u a t e d i n the 4 f i l e s of homemaker a g e n c i e s or governmental b o d i e s a s s o c i a t e d w i t h the p u r c h a s i n g of homemaker s e r v i c e . The w r i t e r , h a v i n g been g i v e n f i l e a c c e s s t o a homemaker agency, s e l e c t e d newspaper c l i p p i n g s , b r o c h u r e s , minutes from agency m e e t i n g s , and l i m i t e d correspondence as the b a s i s f o r r e c o n s t r u c t i n g some of the h i s t o r i c a l b e g i n n i n g s and development of the homemaker s e r v i c e i n B r i t i s h Columbia. The e a r l i e s t correspondence, i n the agency f i l e s concerned a summary of minutes t h a t were r e c o r d e d d u r i n g the f i r s t committee meeting on the v i s i t i n g homemaker i n Vancouver, J a n u a r y , 1938. In t h i s document the homemaker i s d e s c r i b e d as b e i n g p r i m a r i l y a mother s u b s t i t u t e . A b r o c h u r e d e s c r i b i n g the r o l e of the community homemaker (u n d a t e d ) , a l s o found i n the agency f i l e s , r e f e r s t o i t s h i s t o r i c a l b e g i n n i n g s i n B r i t i s h Columbia as b e i n g the e s t a b l i s h m e n t i n 1938 of a homemaker s e r v i c e by the F a m i l y S e r v i c e s of G r e a t e r Vancouver. The brochure goes on t o s t a t e t h a t by 1966 the B.C. government expanded homemaker s e r v i c e t o pers o n s of a l l ages and f a m i l i e s of any s i z e w i t h f e e s b e i n g s e t by a p r e d e t e r m i n e d means t e s t . The homemaker was d e s c r i b e d as someone who p r o v i d e d both household a s s i s t a n c e and p e r s o n a l c a r e t o c l i e n t s i n t h e i r home. A newspaper a r t i c l e from The Vancouver Sun, F e b r u a r y 14,1973 p o r t r a y e d the homemaker as b e i n g sent i n t o the c l i e n t ' s home i n c e r t a i n s i t u a t i o n s when t h e r e i s i l l n e s s . T h i s a r t i c l e s t a t e d e m p h a t i c a l l y , however, t h a t the homemaker never a d m i n i s t e r e d m e d i c a t i o n . Homemaker t r a i n i n g was d e s c r i b e d as i n c l u d i n g a f i r s t a i d and a home n u r s i n g c o u r s e . The Vancouver 5 V o c a t i o n a l I n s t i t u t e was s i t e d as b e i n g the source of homemaker c u r r i c u l u m f o r the e a r l y s e v e n t i e s w i t h the program s h i f t i n g t o the Vancouver Community C o l l e g e by the middle s e v e n t i e s . . The c r e a t i o n of The D i v i s i o n of Long Term Care i n the B r i t i s h Columbia M i n i s t r y of H e a l t h by a p r o v i n c i a l l e g i s l a t i v e a c t i n . the year 1978 appeared t o have a major impact on the . growth and development of the o c c u p a t i o n of homemaking. F o l l o w i n g the department's c r e a t i o n , the number of homemaker a g e n c i e s i n c r e a s e d by a f a c t o r of t e n from 1970 t o 1980. In a document sent t o homemaker a g e n c i e s i n 1978, the B r i t i s h Columbia M i n i s t r y of H e a l t h , i n i t s I n t r o d u c t i o n t o the  Program of Long Term Care, January 1, 1978, d e s c r i b e d the p h i l o s o p h y of l o n g term c a r e i n the f o l l o w i n g manner. The m i n i s t r y s t a t e d t h a t t h e r e had been a l o n g s t a n d i n g i n t e r e s t i n c r e a t i n g a p r o v i n c i a l l y based program of l o n g term c a r e . The key element of such a program was the b e l i e f t h a t i n d i v i d u a l s would want t o s t a y i n t h e i r homes f o r as l o n g as p r a c t i c a l and d e s i r a b l e and t h a t support s h o u l d be p r o v i d e d f o r tho s e needing t h i s s p e c i a l a s s i s t a n c e . In a d d i t i o n t o the home c a r e support t h a t was t o be made a v a i l a b l e f o r tho s e a s s e s s e d as b e i n g i n need of t h i s s e r v i c e , i n s t i t u t i o n a l c a r e a t the p e r s o n a l , i n t e r m e d i a t e , and extended c a r e l e v e l s was a l s o t o be made a v a i l a b l e . The o b j e c t i v e s of the Long Term Care program o u t l i n e d and s t r e s s e d the importance of m a i n t a i n i n g independence and o p t i m a l h e a l t h l e v e l s f o r the c l i e n t . Newspaper a r t i c l e s such as. the one t h a t appeared i n The  P r o v i n c e (Vancouver) on January 5, 1978, a t the b e g i n n i n g of the Long Term Care program, emphasized the importance of keeping 6 i n d i v i d u a l s i n home s e t t i n g s whenever p o s s i b l e . T h i s a r t i c l e from The P r o v i n c e a l s o s t r e s s e d the government's p o i n t of view t h a t homemaker s e r v i c e s were assumed t o be a p o s i t i v e f a c t o r i n r e d u c i n g the demand and the c o s t of more e x t e n s i v e and c o s t l y l e v e l s of c a r e . By 1979, however, t h e r e was an o c c a s i o n a l a r t i c l e a p p e a r i n g i n t h e s e c o l l e c t i o n s of newspaper c l i p p i n g s t h a t seemed t o r a i s e a new i s s u e r e l a t e d t o the a c c e l e r a t i n g development of homemaker s e r v i c e s . That i s s u e c e n t r e d around the i n c r e a s i n g c o m p l e x i t y of c a r e b e i n g r e q u i r e d by the c l i e n t . On June 11, 1979, a C o l o n i s t ( V i c t o r i a ) r e p o r t e r quoted the p r e s i d e n t of a community s o c i a l s e r v i c e a s s o c i a t i o n i n B r i t i s h Columbia as v o i c i n g c o n c erns t h a t the l e v e l of s e r v i c e the homemakers were expected t o p r o v i d e f o r the c l i e n t seemed t o be i n c r e a s i n g i n c o m p l e x i t y . The number of c l i e n t s were observed t o be s t e a d i l y i n c r e a s i n g , as were the hours of s e r v i c e r e q u i r e d . The o c c u p a t i o n of homemaking s e r v i c e s by the n i n e t e e n e i g h t i e s appeared t o have s h i f t e d from i t s i n i t i a l f o c u s of a p r i m a r y concern w i t h s h o r t - t e r m , f a m i l y o r i e n t e d c r i s e s t o i n c l u d e a new and much more complex dimension of the c l i e n t whose needs, were f r e q u e n t l y l o n g term and c h r o n i c i n n a t u r e . T h i s c l i e n t o f t e n r e q u i r e d c o m p l i c a t e d p e r s o n a l c a r e a s s i s t a n c e i n a d d i t i o n t o housekeeping s e r v i c e s . These p a r t i c u l a r f a c e t s of homemaker r o l e change and the t r a i n i n g and p r a c t i c e of homemakers w i l l be examined f u r t h e r i n the r e s e a r c h p r e s e n t a t i o n and a n a l y s i s c h a p t e r s . 7 Development of the Homemaker C u r r i c u l u m The r e c o r d s of the homemaker agency t h a t has been the f o c u s of r e s e a r c h f o r t h i s t h e s i s i n d i c a t e d t h a t a p p r o x i m a t e l y f i f t y f i v e p e r c e n t of i t s homemakers completed the Vancouver Community C o l l e g e Homemaker T r a i n i n g Program. Homemaker t r a i n i n g f o r the r e m a i n i n g homemakers c o n s i s t e d p r i m a r i l y of b r i e f o r i e n t a t i o n s e s s i o n s and an on-going i n - s e r v i c e program t h a t was taught by agency s u p e r v i s o r s and a v a i l a b l e t o a l l of the agency's homemakers. There have never been any compulsory e d u c a t i o n a l r e q u i r e m e n t s i n B r i t i s h Columbia f o r the homemaker who i s employed by a homemaking agency. T h i s s p e c i f i c s i t u a t i o n and the problems t h a t i t r e p r e s e n t s w i l l be f u r t h e r a d d r e s s e d i n the recommendations c h a p t e r of t h i s t h e s i s . : S i n c e the Vancouver Community C o l l e g e c u r r i c u l u m r e p r e s e n t s the f o r m a l c u r r i c u l u m t h a t has been taught t o a m a j o r i t y of homemakers from the agency r e s e a r c h e d , i t was chosen as b e i n g the most a p p r o p r i a t e t r a i n i n g program t o use as the b a s i s f o r a d i s c r e p a n c y e v a l u a t i o n c o n c e r n i n g the t e a c h i n g and p r a c t i c e of the p a r t i c u l a r group of homemakers under s t u d y . There are o t h e r forms of homemaker c u r r i c u l a t h a t have been taught and d e v e l o p e d w i t h i n the p r o v i n c e of B r i t i s h Columbia. However, i t i s not the purpose of t h i s t h e s i s t o comment on the s e programs but t o l o o k s p e c i f i c a l l y a t the c u r r i c u l u m t h a t c o n s t i t u t e s the major e d u c a t i o n a l component f o r the f o r m a l t r a i n i n g of the homemakers from the agency t h a t has been the f o c u s of t h i s t h e s i s . The document, Development of the Vancouver C i t y C o l l e g e  Homemaker Program - Report of Phase I I I , p u b l i s h e d i n 1978, 8 i n d i c a t e s c l o s e h i s t o r i c a l t i e s between f a m i l y s e r v i c e o r g a n i z a t i o n s and the e a r l y growth and e d u c a t i o n a l development of the Homemaker Program i n B r i t i s h Columbia. In 1964 F a m i l y S e r v i c e s C e n t e r s met w i t h r e p r e s e n t a t i v e s of the Vancouver V o c a t i o n a l I n s t i t u t e , r e q u e s t i n g t h a t a "Housekeeping T r a i n i n g Program" be d e v e l o p e d . An a d v i s o r y committee was formed and a p i l o t t r a i n i n g program was d e v e l o p e d and s i t u a t e d at the Vancouver V o c a t i o n a l I n s t i t u t e . S u b s e q u e n t l y , a housekeeping program t o t r a i n I n d i a n women was a l s o developed and funded by the Department of I n d i a n A f f a i r s . In 1965, the p r o v i n c i a l government approved the T r a i n e d F a m i l y A i d e Program. T h i s was a program t h a t c e n t r e d around t o p i c s such as: food p r e p a r a t i o n , h o u s e c l e a n i n g , home n u r s i n g , and human be h a v i o u r needs. In 1966 t h e r e was a push t o d e v e l o p s p e c i f i c , f o r m a l t r a i n i n g programs f o r the homemakers employed by the F a m i l y S e r v i c e C e n t e r s . The document c i t e d above s t a t e s t h a t w i t h i n t h i s p e r i o d a s p e c i f i c program o t h e r than the T r a i n e d F a m i l y A i d Program was needed. T h i s program was the T r a i n e d Homemaker Program, c o n s i s t i n g of s i x weeks of t r a i n i n g and i n c l u d i n g t o p i c s w i t h a broader base of t h e o r y than t h a t p r o v i d e d by the F a m i l y A i d e Program. In 1969 the program was extended t o e i g h t weeks i n o r d e r t o meet what appeared t o be the more complex needs of the c l i e n t . Vancouver Community C o l l e g e r e c o r d s a l s o s t a t e t h a t i n 1975, as p e r s o n a l c a r e needs of the c l i e n t i n t e n s i f i e d , the program, then taught by V.C.C., was extended t o a p e r i o d of t w e l v e weeks. A s u b s e q u e n t l y r e v i s e d c u r r i c u l u m r e f l e c t i n g the c h a n g i n g needs of the homemaker and c l i e n t was put i n t o p l a c e i n 1978. By 1980 9 the homemaker program had been extended t o a . t h i r t e e n week c o u r s e f o r those e n r o l l e d i n the f u l l - t i m e day s e s s i o n s . E v e n i n g s e s s i o n s were a l s o o f f e r e d , c o n s i s t i n g of one s e s s i o n a week f o r a p p r o x i m a t e l y one y e a r . A d d i t i o n a l documents and d i s c u s s i o n s between the w r i t e r and the Vancouver Community C o l l e g e c u r r i c u l u m d e v e l o p e r s i n 1980 i n d i c a t e t h a t the c u r r i c u l u m i s e x p e r i e n c i n g an on-going review w i t h r e v i s i o n s e s p e c i a l l y r e f l e c t i n g the i m p o r t a n t r o l e of Long. Term Care i n the a r e a of homemaker s e r v i c e s . These r e v i s i o n s a l s o appear t o r e f l e c t the r a p i d l y changing n a t u r e of the homemaker's r o l e and the i n c r e a s i n g demands t h a t a re b e i n g p l a c e d on homemaker a g e n c i e s and the c u r r i c u l u m d e v e l o p e r s i n terms of p r o v i d i n g both housekeeping and h e a l t h c a r e a s s i s t a n c e t o the c l i e n t 1 0 Chapter I I  LITERATURE REVIEW I n t r o d u c t i o n A s e a r c h of the l i t e r a t u r e r e l a t e d t o the t o p i c of the homemakers r e v e a l s t h a t t h e r e i s l i t t l e r e s e a r c h m a t e r i a l a v a i l a b l e . The l i t e r a t u r e t h a t does e x i s t can be d i v i d e d i n t o two a r e a s : 1 ) s t u d i e s t h a t a r e p r i m a r i l y d e s c r i p t i v e i n n a t u r e , i n which the contemporary r o l e or the f u t u r i s t i c r o l e of the homemaker was d e l i n e a t e d ; 2) s t u d i e s r e l a t e d t o the c o s t - e f f e c t i v e n e s s of homemaker s e r v i c e s . There does not appear t o be any p u b l i s h e d r e s e a r c h t h a t i s concerned w i t h the a n a l y s i s of congruency or d i s c r e p a n c y between' the t h e o r y and the p r a c t i c e of the homemaker. The l a c k of r e s e a r c h w i t h i n t h i s p a r t i c u l a r a r e a i s an i s s u e t h a t w i l l be ad d r e s s e d i n subsequent c h a p t e r s . The r e s e a r c h s t u d i e s t h a t do e x i s t a r e u s e f u l f o r the purpose of d e l i n e a t i n g some of the o b s e r v a t i o n s and concerns t h a t o t h e r r e s e a r c h e r s have no t e d . There i s l i t e r a t u r e on the t o p i c of homemaking as an o c c u p a t i o n a v a i l a b l e from both American and Canadian s o u r c e s . N u m e r i c a l l y , t h e r e a r e more American a r t i c l e s a v a i l a b l e . However, the Canadian l i t e r a t u r e appears t o be much more a p p l i c a b l e t o the study of the homemaker w i t h i n the c o n t e x t of 11. B r i t i s h Columbia because the p r o v i s i o n of s o c i a l and m e d i c a l s e r v i c e s d i f f e r s i n the two c o u n t r i e s . L i t e r a t u r e from the U n i t e d S t a t e s The a r t i c l e s from the U n i t e d S t a t e s were w r i t t e n p r i m a r i l y d u r i n g the s i x t i e s and s e v e n t i e s and were p r i n c i p l e l y d e s c r i p t i v e i n n a t u r e . These d e s c r i p t i v e s t u d i e s p o r t r a y the r o l e of the homemaker as b e i n g one t h a t i s grounded w i t h i n the c o n t e x t of the f a m i l y . In these s t u d i e s the homemaker was o f t e n d e s c r i b e d as b e i n g a mother s u b s t i t u t e or mother h e l p e r . The homemaker was f r e q u e n t l y r e f e r r e d t o as b e i n g an i n d i v i d u a l who was u t i l i z e d i n s h o r t - t e r m c r i s i s s i t u a t i o n s . The s t u d i e s , " A n a l y s i s of Tasks i n Three Home R e l a t e d O c c u p a t i o n s " ( S h i p l e y , 1 9 6 7 ) and " S u p e r v i s i o n of the P a r a p r o f e s s i o n a l " ( R i p p l e , 1973), b o t h d e s c r i b e a homemaker as b e i n g e s s e n t i a l l y a mature i n d i v i d u a l who h e l p s or r e p l a c e s the.mother i n f a m i l y s e t t i n g s . She was seen as b e i n g a person who was t r a i n e d t o p e r f o r m h o u s e h o l d d u t i e s i n o r d e r t o a s s i s t w i t h the n o r m a l i z a t i o n of f a m i l y l i f e d u r i n g p e r i o d s of s t r e s s . Another study from t h i s p e r i o d r e f e r s t o the homemaker as an i n d i v i d u a l who c o u l d combine both the s k i l l s of homemaking and home n u r s i n g (Lewis and Scheuren, 1975). The homemaker i n the Lewis and Scheuren study was a l s o d e s c r i b e d as b e i n g u n l i s c e n s e d and n o n p r o f e s s i o n a l . The homemaker was someone, who would, when the o c c a s i o n demanded, be p r e p a r e d t o g i v e b oth p e r s o n a l c a r e a s s i s t a n c e and a s s i s t a n c e w i t h housekeeping d u t i e s t o the c l i e n t . 12 The l i t e r a t u r e from the U n i t e d S t a t e s a l s o c o n t a i n s some s t u d i e s t h a t were concerned w i t h the c o s t - e f f e c t i v e n e s s of homemaker s e r v i c e s . One of these s t u d i e s , which a s s e s s e d the u t i l i t y of homemaker s e r v i c e as an a l t e r n a t i v e t o a v a r i e t y of more e x p e n s i v e and complex forms of i n s t i t u t i o n a l c a r e , found t h a t homemaker s e r v i c e c o u l d be g e n e r a l l y d e s c r i b e d as b e i n g more c o s t - e f f e c t i v e than any of the out-of-home a l t e r n a t i v e s s u r v e y e d ( R o b i n s o n , 1974). Canadian L i t e r a t u r e The Canadian l i t e r a t u r e r e l a t e d t o the homemaker c o n s i s t s of t h r e e r e s e a r c h s t u d i e s . These Canadian s t u d i e s a l s o a d d ress the d e s c r i p t i v e a s p e c t s of the homemaker and the i s s u e of the c o s t - e f f e c t i v e n e s s of homemaker s e r v i c e t o the c l i e n t . The f i r s t of the s e s t u d i e s , " V i s i t i n g Homemaker S e r v i c e i n Canada: Report of a Survey w i t h Recommendations", sponsored by the Canadian C o u n c i l on S o c i a l Development (1971), d e s c r i b e d the homemaker as someone who p r o v i d e d an o r g a n i z e d community s e r v i c e . She was r e s p o n s i b l e f o r a s s i s t i n g or r e p l a c i n g the mother i n f a m i l y s e t t i n g s . T h i s r e p o r t a l s o o u t l i n e d the c o s t s of s e r v i c e . I t s t a t e d t h a t t h e r e was no s i m p l e f o r m u l a based on f i n a n c i a l s t a t i s t i c s by which c o s t s and b e n e f i t s t o c l i e n t s c o u l d be a s s e s s e d . T h i s same r e p o r t a l s o a d d r e s s e d the t r a i n i n g of the homemaker. The f i n d i n g s were t h a t the t r a i n i n g or l a c k of t r a i n i n g f o r homemakers v a r i e d w i d e l y a c r o s s Canada. In i t s recommendations the c o u n c i l p r e s e n t e d as i t s f i r s t p r i o r i t y f o r 13 a c t i o n t h a t homemaker s e r v i c e be r e c o g n i z e d as b e i n g a p u b l i c u t i l i t y , one t h a t i s a v a i l a b l e and a c c e s s i b l e t o the whole community. The study a l s o s t r e s s e d the importance of on-going e v a l u a t i o n of homemaker t r a i n i n g programs. The r e m a i n i n g two Canadian s t u d i e s were r e s e a r c h e d w i t h i n the lower m a i n l a n d of B r i t i s h Columbia. In a study e n t i t l e d : Report on Homemakers and R e l a t e d S e r v i c e s i n G r e a t e r Vancouver (Mercer, 1974), homemaker s e r v i c e was d e s c r i b e d as p r o v i d i n g a s s i s t a n c e or mother replacement i n f a m i l y s e t t i n g s and as g i v i n g h e l p t o the c h r o n i c or c o n v a l e s c e n t a d u l t . T h i s r e p o r t d e s c r i b e d the t y p i c a l c l i e n t i n the p e r i o d of the e a r l y s e v e n t i e s as r e q u i r i n g a s s i s t a n c e i n s h o r t - t e r m , s t r e s s r e l a t e d s i t u a t i o n s . . P e r s o n a l c a r e i n v o l v e d o n l y 19% of a l l s e r v i c e s s u r v e y e d . The l a s t of the Canadian l i t e r a t u r e t o be re v i e w e d was a study p r e p a r e d by the S o c i a l P l a n n i n g and Review C o u n c i l of B r i t i s h Columbia (S.P.A.R.C.) i n 1977. T h i s r e p o r t , Homemaker  S e r v i c e f o r E l d e r l y Persons i n B.C. , s u r f a c e d j u s t p r i o r t o the l e g i s l a t i v e a c t i o n s of the B r i t i s h Columbia government i n 1978 when the program of Long Term Care was c r e a t e d . The S.P.A.R.C. r e p o r t a d d r e s s e d the need f o r p r i o r i t i e s i n community c a r e f o r s e n i o r c i t i z e n s . The major recommendation was t h a t homemaker s e r v i c e f o r the e l d e r l y s h o u l d be u n i v e r s a l l y p r o v i d e d on the b a s i s of a h e a l t h / s o c i a l needs assessment and t h a t i t s h o u l d be a v a i l a b l e under a form of comprehensive c a r e . The S.P.A.R.C. study a l s o s t a t e d t h a t p u b l i c f i n a n c i n g of in-home c a r e was l e s s e x p e n s i v e than was the f i n a n c i n g of comparable i n s t i t u t i o n a l c a r e and t h a t i t was almost always more s a t i s f a c t o r y t o the 1 4 c l i e n t . The Canadian l i t e r a t u r e i n d i c a t e s the stage t h a t was b e i n g s e t f o r the enactment of l e g i s l a t i o n r e g a r d i n g Long Term Care f i n a n c i n g of homemakers; a l e g i s l a t i v e a c t i o n t h a t was t o a f f e c t both the homemakers and t h e i r c l i e n t s . 15 . Chapter I I I  CONCEPTUAL FRAMEWORK Framework Design The c o n c e p t u a l framework f o r t h i s paper was d e s i g n e d w i t h a s o c i o l o g i c a l base of i n q u i r y . The p r i m a r y f o u n d a t i o n i s t h e w r i t i n g s of Berger and Luckman (1966) i n the a rea of the s o c i o l o g y of knowledge. S e c o n d a r i l y , the w r i t i n g s of M a c l n t y r e (1977) c o n c e r n i n g c o n f l i c t i n g p e r s p e c t i v e s of h e a l t h c a r e and s o c i a l s e r v i c e s has been chosen t o augment the w r i t i n g s ' o f B erger and Luckman. These two modes of i n q u i r y were a l s o chosen as b e i n g c o m plimentary t o one a n o t h e r , and of p a r t i c u l a r v a l u e i n r e s e a r c h i n g the complex f a c t o r s t h a t i n f l u e n c e the homemaker. S o c i o l o g y of Knowledge Approach The s o c i o l o g y of knowledge approach, as p o s t u l a t e d by Berger and Luckman (1966), i s a u s e f u l framework a g a i n s t which the r o l e change and the e d u c a t i o n a l i s s u e s of the homemaker o r g a n i z a t i o n can be viewed. Berger and Luckman, i n t h e i r p a r t i c u l a r f i e l d of s o c i o l o g i c a l i n q u i r y , l o o k a t the q u e s t i o n of how knowledge comes t o be s o c i a l l y e s t a b l i s h e d as r e a l i t y . For the purposes of homemaker r e s e a r c h t h i s approach e n t a i l s a h i s t o r i c a l u n d e r s t a n d i n g of what s o c i e t y i n the p a s t has u n d e r s t o o d the homemaker t o be, what were her r o l e s , and what 16 was her p e r c e i v e d f u n c t i o n w i t h i n s o c i e t y . A d j u n c t i v e t o her r o l e and f u n c t i o n , what was she taught about homemaking, and what was the scope and l i m i t a t i o n s of t h a t body of knowledge t h a t we r e f e r t o as b e i n g homemaker c u r r i c u l u m . S p e c i f i c a l l y , Berger and Luckman r e f e r t o such a group as the homemakers as b e i n g r e p r e s e n t a t i v e of an i n s t i t u t i o n a l c o n c e p t . The i n s t i t u t i o n a l concept i s t h a t the homemakers are a group which has been s e t a s i d e f o r some s p e c i f i c purpose. T h e i r e x i s t a n c e as a group i s r e c o g n i z e d by the s o c i e t y of which they a r e a p a r t . There i s an i m p l i e d body of knowledge t h a t i s a s s o c i a t e d w i t h t h e i r , r o l e and f u n c t i o n and an i m p l i e d e x t e r n a l c o n t r o l over what they can and cannot do as they p r o v i d e homemaker s e r v i c e t o the c l i e n t . Berger and Luckman a l s o s t a t e t h a t the more conduct i t s e l f i s i n s t i t u t i o n a l i z e d , or seen and a c c e p t e d as b e i n g p a r t of commonplace a c t i v i t e s w i t h i n our l i v e s , then the more p r e d i c t a b l e and c o n t r o l l e d the a c t i v i t y of groups such as the homemakers s h o u l d become. Homemaker R o l e s In terms of the r o l e s t h a t homemakers p l a y and how t h e s e r o l e s may have changed over the y e a r s , Berger and Luckman (1966) contend t h a t a l l i n s t i t u t i o n a l i z e d c o n d u c t , such as t h a t of homemaking, i n v o l v e s the concept of a r o l e . The r o l e of an i n d i v i d u a l i s p a r t of the c o n t r o l l i n g c h a r a c t e r of i n s t i t u t i o n a l i z a t i o n . I f the r o l e and r o l e s t a b i l i t y of the i n d i v i d u a l i s indeed c r u c i a l as a c o n t r o l f a c t o r , then problems w i l l a r i s e i n s i t u a t i o n s i n which the i n d i v i d u a l ' s r o l e i s 17 r a p i d l y c h a n g i n g . The f i n d i n g s of t h i s t h e s i s study i n d i c a t e t h a t the r o l e of the homemaker i n 1980 i s not congruent w i t h her r o l e i n 1976. Gi v e n the r a p i d l y i n c r e a s i n g c o m p l e x i t y of c l i e n t needs, the r o l e of the homemaker may c o n t i n u e t o change. The i n s t i t u t i o n a l c o n s t r a i n t s t h a t a re p l a c e d on the homemaker a l s o appear t o d e f i n e her r o l e of s e r v i c e t o the c l i e n t . Berger and Luckman s t a t e t h a t i n s t i t u t i o n s c o n t r o l human conduct by e s t a b l i s h i n g p r e d e f i n e d p a t t e r n s of conduct which c h a n n e l i t i n one d i r e c t i o n as a g a i n s t the many o t h e r d i r e c t i o n s t h a t t h e o r e t i c a l l y would be p o s s i b l e . The homemaker i s d i r e c t e d by the homemaker agency as t o c e r t a i n p r e s c r i b e d d u t i e s t h a t she i s t o p r o v i d e f o r s p e c i f i c c l i e n t s . She may. be f u r t h e r l i m i t e d i n her p a t t e r n s of conduct by the e d u c a t i o n a l t r a i n i n g she has or has not r e c e i v e d . I d e a l l y , the r o l e , t h e o r y , and p r a c t i c e of a body such as the homemakers s h o u l d mesh t o g e t h e r w i t h i n a g e n e r a l i z e d p a t t e r n of congruency. However, i n the case of the homemakers as o u t l i n e d i n t h i s t h e s i s , t h e r e appears t o have been r a p i d r o l e change and c o r r e s p o n d i n g a r e a s of d i s c r e p a n c y between t h e o r y ( t r a i n i n g ) and a c t u a l p r a c t i c e . When t h i s o c c u r s , both the homemaker's u n d e r s t a n d i n g s of who she i s and what s e r v i c e s she s h o u l d be g i v i n g t o the c l i e n t may be d i s t o r t e d . The u n d e r s t a n d i n g s of s o c i e t y a t l a r g e as t o the r o l e of the homemaker may a l s o be p o o r l y d e f i n e d . C o n f l i c t i n g P e r s p e c t i v e s i n H e a l t h Care and S o c i a l S e r v i c e s A second v i e w p o i n t from which the r o l e and f u n c t i o n of the 1 8 homemaker can be u n d e r s t o o d i s d e r i v e d from the s o c i o l o g i c a l w r i t i n g s of S a l l y M a c l n t y r e . One p a r t i c u l a r study ( M a c l n t y r e , 1977) o u t l i n e s a d u a l i t y of c o n c e p t s w i t h i n the a r e a of h e a l t h c a r e and s o c i a l s e r v i c e . In her s t u d i e s M a c l n t y r e used the i s s u e of o l d age as a s o c i a l problem as the b a s i s of r e s e a r c h . She p o i n t e d o u t , though, t h a t her r e s e a r c h i s of r e l e v a n c e not o n l y t o the problem of o l d age, but a l s o t o h e a l t h and s o c i a l s e r v i c e problems of c h r o n i c i t y and dependency i n g e n e r a l . She s t a t e d t h a t i n England t h e r e appears t o have been t e n s i o n between the o r g a n i z a t i o n a l and the h u m a n i t a r i a n p e r s p e c t i v e w i t h i n the l a s t c e n t u r y and a h a l f . In the h u m a n i t a r i a n p e r s p e c t i v e o l d age (as w e l l as c h r o n i c i t y and dependency i n g e n e r a l ) , i s seen as b e i n g p r o b l e m a t i c because i t encompasses s u f f e r i n g and o b s e r v a b l e c o s t s f o r the i n d i v i d u a l . The a c t i o n , component concerns the q u e s t i o n of how b e s t t o p r e v e n t t h e s e problems of o l d age, c h r o n i c i t y , and dependency by r e d u c i n g the c o s t s t o the i n d i v i d u a l e x p e r i e n c i n g them. The o r g a n i z a t i o n a l p e r s p e c t i v e sees o l d age, c h r o n i c i t y , and dependency as a s o c i a l p roblem because t h e r e i s a burden of dependency t h a t i s p l a c e d p r i m a r i l y on the p r o d u c t i v e members of s o c i e t y . The a c t i o n component here i n v o l v e s a c o n s i d e r a t i o n of how b e s t t o reduce the s o c i a l c o s t s t h a t are p l a c e d on the community by t h e s e i n d i v i d u a l s who r e q u i r e h e a l t h c a r e and s o c i a l a s s i s t a n c e . I t w i l l be argued i n t h i s t h e s i s t h a t both the h u m a n i t a r i a n and the o r g a n i z a t i o n a l p e r s p e c t i v e a r e o p e r a t i v e w i t h i n the a r e a of the homemakers. These two c o n c e p t s a r e p a r t i c u l a r l y u s e f u l i n d e t e r m i n i n g some of the complex f a c t o r s t h a t i n f l u e n c e not o n l y the homemaker, the c l i e n t , and s o c i e t y i n g e n e r a l . 1 9 Chapter IV . METHODOLOGY Overview I n s t r u m e n t a t i o n f o r the r e s e a r c h was chosen w i t h the s p e c i f i c i n t e n t of a n a l y z i n g t h e - r o l e change of the homemaker over a d e f i n e d p e r i o d of time and the d i s c r e p a n c y t h a t might e x i s t between the c u r r i c u l a r t h e o r y and the a c t u a l p r a c t i c e of homemakers i n the c l i e n t ' s home. For the purpose of compar i s o n , one hundred c l i e n t f i l e s each from 1976 and from 1980 were randomly s e l e c t e d . These y e a r s were chosen so t h a t the r o l e and p r a c t i c e of the homemaker c o u l d be a s s e s s e d p r i o r t o and f o l l o w i n g the i n t r o d u c t i o n of the Long Term Care l e g i s l a t i o n i n 1978. Content a n a l y s i s of t h i s f i l e d a ta was used t o reduce the i n f o r m a t i o n c o n t a i n e d w i t h i n t h e s e c l i e n t f i l e s t o the form of manageable u n i t s . A f t e r the da t a g a t h e r i n g was completed, c o n t e n t r e d u c t i o n of t h i s d a t a t o m u t u a l l y e x c l u s i v e u n i t s of i n f o r m a t i o n was then employed. The pr e p a r e d c a t e g o r i e s of i n f o r m a t i o n o b t a i n e d from the 1976 and 1980 c l i e n t f i l e s were then s t a t i s t i c a l l y compared u s i n g the S t a t i s t i c a l Package f o r the S o c i a l S t u d i e s program (S.P.S.S.). The next s t e p i n the methodology d e s i g n was t o compare the p r a c t i c e c a t e g o r i e s o b t a i n e d w i t h the 1980 c u r r i c u l u m of the homemaker t r a i n i n g program. The Provus D i s c r e p a n c y Model ( P r o v u s , 1971) was used i n t h i s i n s t a n c e . The Provus Model i s an e v a l u a t i v e t o o l t h a t a l l o w s f o r the a n a l y s i s of congruence 20 and/or d i s c r e p a n c y between c u r r i c u l a r . t h e o r y and p r a c t i c e . The c u r r i c u l a r t h e o r y was t h a t . o f the 1980 homemaker t r a i n i n g program as t aught by the Vancouver Community C o l l e g e ; a program t h a t c o r r e s p o n d s t o the t r a i n i n g r e c e i v e d by a m a j o r i t y of the homemakers w i t h i n the agency r e s e a r c h e d f o r t h i s t h e s i s . The f i n a l methodology t o be employed was t h a t of f o c u s s e d i n t e r v i e w s c o n s i s t i n g of d a t a from r e p r e s e n t a t i v e f i e l d s u p e r v i s o r s w i t h i n the agency b e i n g s t u d i e d . The i n t e r v i e w s s e r v e d t o expand the i n f o r m a t i o n a v a i l a b l e from a l l s o u r c e s , r e g a r d i n g t h e . r o l e and t r a i n i n g of the homemaker. These methods were s e l e c t e d not o n l y f o r t h e i r a b i l i t y t o p r o v i d e t o o l s f o r a n a l y z i n g some of the u n d e r l y i n g c o n c e p t u a l q u e s t i o n s about the homemakers but a l s o w i t h the purpose i n mind of c r e a t i n g a m u l t i - d i m e n s i o n a l view of the homemaker's r o l e , t h e o r y , and p r a c t i c e w i t h i n the s p e c i f i e d p e r i o d of t i m e . Content A n a l y s i s In t h i s t h e s i s c o n t e n t a n a l y s i s as d e s c r i b e d by H o l s t i (1969) was used s p e c i f i c a l l y f o r the purpose of r e d u c i n g the amount of d e s c r i p t i v e m a t e r i a l r e l a t e d t o the p r a c t i c e of homemakers and biodemographic c h a r a c t e r i s t i c s about the c l i e n t t o the form of manageable u n i t s . Content a n a l y s i s p r o v i d e d a t e c h n i q u e whereby i n f e r e n c e s about homemaker p r a c t i c e d a t a o b t a i n e d from the c l i e n t ' s case n o t e s c o u l d be o b j e c t i v e l y and s y s t e m a t i c a l l y i d e n t i f i e d , and the s p e c i f i c c h a r a c t e r i s t i c s of t h i s m a t e r i a l e x t r a c t e d f o r a n a l y s i s . The w r i t e r i n i t i a l l y f o r m u l a t e d a s e r i e s of biodemographic 21 and homemaker p r a c t i c e a r e a s of i n t e r e s t t h a t were e x p e c t e d t o be found w i t h i n the c l i e n t f i l e i n f o r m a t i o n . These were: the c l i e n t ' s age; sex; a r e a of c i t y r e s i d i n g i n ; method of r e f e r r a l ; the number i n the f a m i l y u n i t of the c l i e n t ; the r e a s o n ( s ) why a s s i s t a n c e was r e q u i r e d by the homemaker; and the areas of p r a c t i c e the homemaker was r e c o r d e d as h a v i n g performed i n the c l i e n t ' s home. C a r e f u l c o n s t r u c t i o n of these c a t e g o r i e s . w a s seen as b e i n g an i m p o r t a n t p r e l i m i n a r y s t e p i n meeting both the t h e o r e t i c a l r e q u i r e m e n t s of the problem a t hand, as w e l l as the r e c o g n i z e d canons of c a t e g o r y c o n s t r u c t i o n . A d d i t i o n a l l y , a p r e c i s e o p e r a t i o n a l d e f i n i t i o n of c a t e g o r i e s was d e c i d e d upon i n o r d e r t h a t the c o d i n g c o u l d p r o ceed w i t h a c c e p t a b l e l e v e l s of r e l i a b i l i t y , as has been suggested by H o l s t i and o t h e r w r i t e r s i n t he f i e l d of c o n t e n t a n a l y s i s ( H o l s t i , 1 9 6 9 ) . The w r i t e r a l s o chose the use of c o n t e n t a n a l y s i s f o r t h i s p a r t i c u l a r t a s k of i n f o r m a t i o n a n a l y s i s because a l l c o n t e n t a n a l y s i s i s based upon the c o m p a r a t i v e mode ( H o l s t i , 1969). By r e d u c i n g i n f o r m a t i o n t o m u t u a l l y e x c l u s i v e u n i t s , the homemaker case note data c o u l d be e a s i l y t a b u l a t e d and c r o s s r e f e r e n c e d . Another, c o n c e r n of the w r i t e r was w i t h i n the a r e a of o b j e c t i v e as opposed t o s u b j e c t i v e i n f o r m a t i o n g a t h e r i n g . These p a r t i c u l a r c l i e n t f i l e s were c o m p i l e d by f i e l d s u p e r v i s o r s , who e n t e r e d s p e c i f i c d a t a a t the time of c l i e n t p r o c e s s i n g and d u r i n g the months or y e a r s the c l i e n t ' s f i l e was a c t i v e . U s i n g the c o n t e n t a n a l y s i s method of r e t r i e v i n g i n f o r m a t i o n about c l i e n t c h a r a c t e r i s t i c s and homemaker p r a c t i c e , i t was p o s s i b l e i n t h i s i n s t a n c e t o make use of an u n o b t r u s i v e r e s e a r c h t e c h n i q u e (Webb e t a l . , 1966). I n f o r m a t i o n w r i t t e n a t the time 22 i n which t h e r e i s ongoing i n t e r a c t i o n between a f i e l d s u p e r v i s o r , a homemaker, and a c l i e n t p r o v i d e s a unique d a t a v i g n e t t e . Webb and S a l a n c i k ( 1 9 6 5 ) d e s c r i b e d t h i s k i n d of documentary e v i d e n c e as b e i n g f a r s u p e r i o r t o the r e c a l l of e v e n t s ; the p a l e s t ink of t h e s e documents r e v e a l s more of the past than would be p o s s i b l e i n volumes of v e r b a l r e c o l l e c t i o n s . The method of c o n t e n t a n a l y s i s f u r t h e r e l i m i n a t e d the p o s s i b l e c o n t a m i n a t i o n of data t h a t might have o c c u r r e d w i t h the use of o t h e r forms of data g a t h e r i n g ; forms i n which i n t e r a c t i o n between the. r e s e a r c h e r and t h e ; s u b j e c t g e n e r a t i n g and r e c o r d i n g i n f o r m a t i o n c o u l d a f f e c t the n a t u r e of the response ( H o l s t i , . 1969). The biodemographic i n f o r m a t i o n was r e t r i e v e d w i t h o u t d i f f i c u l t y and r e c o r d e d i n the form of m u t u a l l y e x c l u s i v e u n i t s . The c a t e g o r y of c l i e n t d i a g n o s i s (or the reason why the c l i e n t r e q u e s t e d a s s i s t a n c e from the homemaker agency) was r e t r i e v e d i n a s i m i l a r manner. However, the a r e a of homemaker p r a c t i c e r e q u i r e d much more e x h a u s t i v e a n a l y s i s b e f o r e the w r i t e r was a b l e t o reduce the e x t e n s i v e c l i e n t n otes t o manageable u n i t s . The u l t i m a t e g o a l f o r t h i s more complex a r e a of a n a l y s i s was t o determine what the communication was about. T h i s g o a l of r e d u c t i o n of p r a c t i c e n o t a t i o n t o m u t u a l l y e x c l u s i v e c a t e g o r i e s was o b t a i n e d a f t e r many r e a d i n g s and r e - r e a d i n g s of c l i e n t f i l e s i n o r d e r t o determine how many times and w i t h what v a r i a t i o n c e r t a i n homemaker p r a c t i c e c a t e g o r i e s appeared f o r each c l i e n t . As H o l s t i ( 1 9 6 9 ) has n o t e d i n h i s r e s e a r c h i n the f i e l d of c o n t e n t a n a l y s i s , the theme, the s i n g l e a s s e r t i o n about the s u b j e c t b e i n g i n v e s t i g a t e d , i s o f t e n the most u s e f u l u n i t of 23 c o n t e n t a n a l y s i s . Once the c o n t e n t a n a l y s i s was completed, and the s e s p e c i f i c c a t e g o r i e s r e c o r d e d , the next phase was the s t a t i s t i c a l a n a l y s i s of the c l i e n t case note d a t a . S t a t i s t i c a l Package f o r the S o c i a l S c i e n c e s The S t a t i s t i c a l Package f o r the S o c i a l S c i e n c e s was chosen f o r use i n the s t a t i s t i c a l a n a l y s i s of the d a t a generated from the c l i e n t f i l e s . The S.P.S.S. i s an i n t e g r a t e d system of computer programs t h a t has been d e s i g n e d s p e c i f i c a l l y f o r the a n a l y s i s of s o c i a l s c i e n c e d a t a . I t c o n t a i n s p r o c e d u r e s t h a t are- e s p e c i a l l y u s e f u l f o r o b t a i n i n g d e s c r i p t i v e s t a t i s t i c s , s i m p l e f r e q u e n c y d i s t r i b u t i o n s , and c r o s s t a b u l a t i o n s . The Provus D i s c r e p a n c y Model A c e n t r a l q u e s t i o n f o r t h i s e v a l u a t i v e t h e s i s i s the e x t e n t of congruency or d i s c r e p a n c y between the c u r r i c u l u m of the f o r m a l t r a i n i n g program f o r the homemakers b e i n g r e s e a r c h e d and the a r e a s of p r a c t i c e i n which she i s t y p i c a l l y engaged w i t h i n the home of the c l i e n t . The Provus D i s c r e p a n c y Model of E v a l u a t i o n ( P r o v u s , 1971) was chosen as an a p p r o p r i a t e t o o l by which t h e s e a r e a s of congruency and/or d i s c r e p a n c y c o u l d be c l e a r i l y i d e n t i f i e d and a n a l y z e d . Provus s t a t e s t h a t an u n d e r l y i n g i n t e r e s t i n e v a l u a t i o n i s d e r i v e d from a b a s i c d e s i r e t o p r o v i d e o p t i m a l e d u c a t i o n a l programs and t h a t w i t h i n t h i s 24 framework of s e e k i n g o p t i m a l programs t h e r e s h o u l d always be an u n d e r l y i n g s k e p t i c i s m about the p r e s e n t program. He goes on t o suggest t h a t we e v a l u a t e on the assumption t h a t a problem (a d i s c r e p a n c y ) e x i s t s , t h a t a s o l u t i o n can be found, and t h a t e v a l u a t i o n w i l l a i d i n the s o l u t i o n p r o c e s s . He f u r t h e r d e s c r i b e s the e v a l u a t i o n of any i n s t i t u t i o n as i n v o l v i n g two major s t e p s : 1) the adequate d e f i n i n g of the s t a n d a r d s t h a t must be f o l l o w e d ; and 2) a comparison of the a c t u a l performance of the i n s t i t u t i o n w i t h those s t a n d a r d s . In the Provus model t h e r e are f i v e s t a g e s : Stage I : D e s ign of the Program Stage I I : Program I n s t i l l a t i o n and Congruence T e s t i n g Stage I I I : D e l i n e a t i o n of I n t e r i m P r o d u c t s Stage IV: T e r m i n a l P r o d u c t s . Stage V: Cost E f f e c t i v e n e s s of the Program. The f i f t h stage of t h i s model has been d e l e t e d from the a n a l y s i s on the grounds t h a t i t r e p r e s e n t s a phase of r e s e a r c h t h a t i s not c e n t r a l t o the i s s u e of congruency and/or d i s c r e p a n c y b e i n g pursued w i t h i n t h i s p a r t i c u l a r s t u d y . W i t h i n the parameters of t h i s t h e s i s Stages I t h r o u g h IV have been used as f o l l o w s : Stage I a n a l y z e d the t e r m i n a l g o a l ( s ) and the i n t e r i m o b j e c t i v e ( s ) of the Vancouver Community C o l l e g e Homemaker T r a i n i n g Program (1980 c u r r i c u l u m g u i d e ) . Stage I I matched the homemaker p r a c t i c e d a t a t h a t was o r i g i n a l l y d e r i v e d from the c l i e n t case notes w i t h the c u r r i c u l u m g u i d e ' s g o a l s and o b j e c t i v e s . Stage I I I was employed t o a n a l y z e assumed r e l a t i o n s h i p s between -processes and the i n t e r i m p r o d u c t s . S p e c i f i c a l l y , what competencies the homemaker s t u d e n t s h o u l d be 25 a b l e t o p r a c t i c e w i t h i n c e r t a i n c u r r i c u l u m a r e a s w e r e e x a m i n e d i n t h i s s t a g e . S t a g e I I I was a l s o t h e s t a g e a t w h i c h t h e p r o d u c t was m e a s u r e d . F o r e x a m p l e , w h a t m i n i m u m n u m b e r o f h o u r s a p p e a r i n t h e s t u d e n t g u i d e l i n e s c o n c e r n i n g s t u d e n t l e a r n i n g a c t i v i t i e s . I n S t a g e I V t h e r e w e r e e v a l u a t i v e c o n c l u s i o n s r e a c h e d a s t o w h e t h e r o r n o t t h e c o m b i n a t i o n o f i n t e r i m p r o d u c t s e t s a p p e a r e d t o h a v e met t h e m a j o r t e r m i n a l g o a l o r o b j e c t i v e . I n S t a g e I V , t h e f i n a l s t a g e u s e d f o r t h i s a n a l y s i s , t h e s p e c i f i c p r a c t i c e c a t e g o r y o f t h e h o m e m a k e r b e i n g a s s e s s e d e i t h e r m a t c h e d t h e f o r m a t o f t h e c u r r i c u l u m g u i d e , o r a d i s c r e p a n c y was n o t e d . I t s h o u l d be n o t e d t h a t o n l y t h e p r a c t i c e a r e a s r e t r i e v e d f r o m t h e 1 9 8 0 s t a t i s t i c a l a n a l y s i s w e r e , u s e d f o r c o n g r u e n c e / d i s c r e p a n c y e v a l u a t i o n . I n t e r v i e w s The f i n a l mode o f i n s t r u m e n t a t i o n was t h a t o f b r i e f , f o c u s e d i n t e r v i e w s w i t h f o u r f i e l d s u p e r v i s o r s who w e r e r e p r e s e n t a t i v e l y c h o s e n f r o m t h e a g e n c y w h e r e t h e c l i e n t d a t a was g e n e r a t e d . T h e p u r p o s e o f t h e s e i n t e r v i e w s was p r i m a r i l y t o g a t h e r a d d i t i o n a l i n f o r m a t i o n r e l a t e d t o t h e r o l e a n d t r a i n i n g o f t h e h o m e m a k e r . Homemaker s u p e r v i s o r s w i t h i n t h e a g e n c y w e r e r e p r e s e n t a t i v e l y s e l e c t e d f r o m t h e a r e a s o f t h e g r e a t e r V a n c o u v e r a r e a i n w h i c h t h e a g e n c y b e i n g s t u d i e d i s l o c a t e d . A f o r m o f f o c u s s e d i n t e r v i e w t e c h n i q u e was u s e d . S p e c i f i c a l l y , t h e s u p e r v i s o r s w e r e a s k e d q u e s t i o n s t h a t r e l a t e d t o t h e r o l e , t h e o r y a n d p r a c t i c e o f t h e h o m e m a k e r s w i t h i n t h e i r p a r t i c u l a r 26 agency. The t h r e e q u e s t i o n s were: 1) What do you c o n s i d e r t o be the r o l e of the homemaker as she a s s i s t s her c l i e n t s ? 2) I s t h e r e any a rea of d i s c r e p a n c y between what the homemakers. i n t h i s agency have been t r a i n e d t o do, and what she may a c t u a l l y be r e q u i r e d t o do i n the home of the c l i e n t ? 3) Does the p r e s e n t homemaker t r a i n i n g program meet the needs of the homemakers w i t h i n t h i s agency i n t h e i r a s s i s t a n c e t o the c l i e n t ? The d a t a from the i n t e r v i e w s was then c o n t e n t a n a l y z e d so t h a t p a t t e r n s of response to. the q u e s t i o n s c o u l d be s t u d i e d . The p a t t e r n s of: responses p r o v i d e d i n f o r m a t i o n as t o how the s u p e r v i s o r s viewed the homemakers w i t h i n t h i s p a r t i c u l a r agency. The o v e r a l l i n t e n t of these b r i e f i n t e r v i e w s was t h a t of p r o v i d i n g another v i e w p o i n t from which t h i s complex area of homemaker t h e o r y and p r a c t i c e c o u l d be seen. Summary The methods of r e s e a r c h were: a s t a t i s t i c a l a n a l y s i s of c l i e n t f i l e d a t a ; a Provus D i s c r e p a n c y a n a l y s i s of the p r a c t i c e and t h e o r y of the homemakers s t u d i e d ; and s t r u c t u r e d i n t e r v i e w s w i t h r e p r e s e n t a t i v e homemaker s u p e r v i s o r s . The r e s u l t s of the s t a t i s t i c a l and the d i s c r e p a n c y a n a l y s e s w i l l be d i s c u s s e d and p r e s e n t e d i n d e t a i l e d , t a b u l a r form i n the next c h a p t e r . The f i n d i n g s of the i n t e r v i e w s w i l l a l s o be presented- i n Chapter VI and w i l l p r o v i d e a d d i t i o n a l i n f o r m a t i o n about the s u p e r v i s o r s ' u n d e r s t a n d i n g s of the r o l e , t h e o r y , and p r a c t i c e of the homemaker t h a t was not o b t a i n e d from an a n a l y s i s of the c l i e n t f i l e s . 27 Chapter V  RESULTS I n t r o d u c t i o n T h i s r e s e a r c h study c o n c e r n i n g the r o l e , t r a i n i n g , and p r a c t i c e of the homemaker has i n v o l v e d the n e c e s s i t y of comparing and a n a l y z i n g a v a r i e t y of f a c t o r s t h a t are c o n t a i n e d w i t h i n the o v e r a l l concept of the homemaker. O v e r a l l , the f i n d i n g s of t h i s r e s e a r c h study p r e s e n t a composite p i c t u r e of a s p e c i f i c group of homemakers and t h e i r c l i e n t s i n which t h e r e has been s i g n i f i c a n t change. The r o l e and p r a c t i c e of the homemaker appears t o have undergone o b s e r v a b l e a l t e r a t i o n s . The c u r r i c u l a r t h e o r y does not i n every i n s t a n c e appear t o match the a c t u a l p r a c t i c e of the homemaker. However, the da t a a n a l y s i s does i n d i c a t e more congruency than d i s c r e p a n c y . S p e c i f i c a l l y , the s t a t i s t i c a l a n a l y s i s r e v e a l s the t y p i c a l homemaker c l i e n t i n 1980 as b e i n g o l d e r than her 1976 c o u n t e r p a r t . T h i s c l i e n t of 1980 i s a l s o r e p r e s e n t a t i v e of a s m a l l e r f a m i l y u n i t ; r e s i d e s p r i m a r i l y i n the c i t y of Vancouver; i s more apt t o be r e f e r r e d by Long Term Care; has a s i g n i f i c a n t l y h i g h e r p e r c e n t a g e of p s y c h i a t r i c and m e d i c a l problems; but r e q u i r e s l e s s a s s i s t a n c e w i t h c h i l d c a r e i n the home. In terms of t h e o r y and p r a c t i c e the c u r r i c u l u m of the homemaker t r a i n i n g program t h a t was completed by a s i g n i f i c a n t 28 perce n t a g e of homemakers i n the agency s u r v e y e d proved t o be p r i m a r i l y c ongruent w i t h the e x c e p t i o n of t h r e e out of the e l e v e n c a t e g o r i e s t a b u l a t e d . The a r e a s of p r a c t i c e and t h e o r y d i s c r e p a n c y o c c u r r e d i n the c a t e g o r i e s o f : m o n i t o r i n g the s t a t e of h e a l t h of the c l i e n t , a s s i s t i n g the c l i e n t w i t h m e d i c a t i o n , and r e p l a c i n g Home Care nurses on a temporary b a s i s . These t h r e e a r e a s of d i s c r e p a n c y a re e x p l i c i t l y e x c l u d e d from the V.C.C. c u r r i c u l u m of 1980, and the premise f o r t h e i r e x c l u s i o n w i l l be a d d r e s s e d i n the c o n c l u d i n g c h a p t e r . T h i s c h a p t e r c o n t a i n s a d e t a i l e d p r e s e n t a t i o n of both the s t a t i s t i c a l a n a l y s i s of the c l i e n t f i l e s as w e l l as an . e v a l u a t i o n of the t h e o r y and p r a c t i c e of the homemaker. Because the s t a t i s t i c a l t a b l e s t h a t . f o l l o w c o n t a i n t h r e e s e p a r a t e a n a l y s e s of d a t a , a guide t o the s e t a b l e s has been p r o v i d e d f o r the r e a d e r . A w r i t t e n summary of b o t h the s t a t i s t i c a l t a b l e s and the e v a l u a t i o n data a re i n c l u d e d i n t h i s c h a p t e r . . Guide t o the S t a t i s t i c a l T a b l e s C r o s s - t a b u l a t i o n s were done between the y e a r s 1976,1980, and the f o l l o w i n g v a r i a b l e s t h a t were o b t a i n e d from the homemaker c l i e n t case n o t e s : sex of c l i e n t , age, number i n f a m i l y u n i t , a r e a of r e s i d e n c e , method of r e f e r r a l ; combined p r a c t i c e c a t e g o r i e s of t o t a l p e r s o n a l c a r e , t o t a l c h i l d c a r e , t o t a l h o u s e k e e p i n g ; combined d i a g n o s i s c a t e g o r i e s of t o t a l p s y c h i a t r i c p roblems, t o t a l m e d i c a l problems, and t o t a l c h i l d c a r e needs. For each of the s e v a r i a b l e s t h r e e r e s e a r c h q u e s t i o n s were 29 t e s t e d t h a t r e q u i r e d s e p a r a t e a n a l y s i s of the d a t a . In the f i r s t i n s t a n c e the w r i t e r was i n t e r e s t e d i n d e t e r m i n i n g any degree of d i f f e r e n c e t h a t might have e x i s t e d between the 1976 and 1980 c l i e n t d a t a . The second r e s e a r c h a r e a of a n a l y s i s l o o k e d a t s i m i l a r d i f f e r e n t i a t i o n s between.1976 and 1980 d a t a t h a t d i d not i n c l u d e Long Term Care c l i e n t s . In the t h i r d a r e a of a n a l y s i s the w r i t e r compared 1980 Long Term Care c l i e n t s w i t h 1980 non-Long Term Care c l i e n t s . In a l l t h r e e a r e a s of r e s e a r c h i n t e r e s t the q u e s t i o n was t h a t of a s c e r t a i n i n g what p a t t e r n s of change might o c c u r . In the case of the Long Term Care v a r i a b l e , the i n t e n t was a l s o t o d i s c o v e r , i f p o s s i b l e , the e x t e n t t o which the Long Term Care c l i e n t might d i f f e r from o t h e r c l i e n t s who had not been c a t e g o r i z e d as b e l o n g i n g t o Long Term Care. 30 TABLE I Cross T a b u l a t i o n of Sex and Year 1976 1 980 1980CLTC) I980(not LTC) Male Female Couple 11 (11.1) 87 (87.9) 1 ( 1 . 0 ) 19 (19.0) 79 (79.0) 2 ( 2.0) 8 (20.5) 31 (79.5) 0 ( 0.0) 11 ( 1 8 . 0 ) 48 (78.7) 2 ( 3.3) T o t a l 99 100 39 61 S i g n i f i c a n c e Tests 2. 1976 vs. 1980 % = 2.847 (df = 2; P = 0.241) 1976 vs. I980(not LTC) % = 2.729 (df = 2; P = 0.255) 1980(LTC) vs. I980(not LTC) X v = 1.358 (df = 2; P = 0.507) Long term care 3 1 T a b l e I I Cros s T a b u l a t i o n of Age and Year 1976 y e a r s f % f 10 - 1 9 0 ( 0.0) 1 20 - 29 23 (25.0) 8 30 - 39 19 (20.7) 6 40 - 49 .3 ( 3.3) 4 50 - 59 8 .( 8,7) 7 60 - 69 9 ( 9.8) 20 70 - 79 1 7 ( 1 8 . 5 ) 16 80 - 89 9 ( 9.8) 22 90 - 99 4 ( 4.3) 1 T o t a l 92 85 1 980 1980(LTC) 1980(not LTC) % f % f % ( 1.2) .0 ( 0.0) 1 ( 2.0) ( 9.4) 0 ( 0.0) 8 (16.3) ( 7.1) 0 ( 0 . 0 ) 6 (12.2) ( 4.7) 0 ( 0 . 0 ) 4 ( 8.2) ( 8.2) 3 ( 8.3) 4 ( 8.2) (23.5) 10 (27.8) 10 (20.4) (18.8) 6 (16.7) 10 (20.4) (25.9) .1 7 (47.2) 5 (10.2) ( 1.2) 0 ( 0.0) . 1 ( 2.0) 36 49 S i g n i f i c a n c e T e s t s 1976 v s . 1980 K e n d a l l ' s Tau C = 1976 v s . I980(not LTC) K e n d a l l ' s Tau C = 1980(LTC) v s . I980(not LTC) K e n d a l l ' s Tau C = 0.281;(P = 0.077;(P = -0.512;(P = 0.001 ) . 0.414) . 0.000) . 32 Table I I I Cr o s s T a b u l a t i o n of Number i n F a m i l y U n i t and Year 1976 1980 1980(LTC) I980(not LTC) no. f % f % f % f 1 1 41 (41.4) 46 (46.5) 26 (68.4) 20 (32.8) 2 1 5 (15.2) 29 (29.3) 1 1 (28.9) 18 (29.5) 3 22 (22.2) 10 (10.1) 1 ( 2.6) 9 (14.8) 4 7 ( 7.1) 8 ( 8.1) 0 ( o.'o) 8 (13.1) 5 6 C 6.1) 2 ( 2.0) 0 ( 0.0) 2 ( 3.3) 6 7 ( 7.1) 1 ( 1.0) 0 ( 0.0) 1 ( 1 .6) 7 1 ( 1.0) 3 ( 3.0) 0 ( 0.0) 3 ( 4.9) T o t a l 99 99 38 61 S i g n i f i c a n c e T e s t s 1976 v s . 1980 K e n d a l l ' s Tau C = 1976 v s . I980(not LTC) K e n d a l l ' s Tau C = 1980(LTC) v s . I980(not LTC) K e n d a l l ' s Tau C = -0.135;(P = 0.026;(P = 0.439;(P = 0.087) . 0.777) . 0.000) . 33 T a b l e IV Cros s T a b u l a t i o n of Area of Residence and Year Area Where L i v i n g 1976 1980 1980(LTC) I980(not LTC) a Code f I . f 1 f % •f I 1 4 ( 4 . 1 ) 8 ( 8.2) '3 ( 7.9) 5 ( 8.5) 2 1 0 (10.2) 2 ( 2.1) 1 ( 2.6) 1 (•' 1.7) 3 4 ( 4.1 2 ( 2.1) 0 ( 0.0) 2 ( 3.4) 4 4 ( 4.1) 6 ( 6.2) 2 ( 5.3) 4 ( 6.8) 5 0 ( 0.0) : 6 ( 6.2) 1 ' ( 2.6) 5 ( 8.5) 6 2 ( 2.0) 1 ( 1.0) 0 ( 0.0) 1 ( 1.7) 7 2 ( 2.0) 3 ( 3.1) 1 ( 2.6) 2 ( 3.4) 8 7 ( 7.1) 7 ( 7.2) 2 ( 5.3) 5 ( 8.5) 9 2 ( 2.0) 3 ( 3.1) 1 ( 2.6) 2 ( 3 . 4 ) 10 2 ( 2.0) 2 ( 2.1) 1 ( 2.6) 1 ( 1.7) 1 1 1 1 (11.2) 1 6 (16.5) 9 (23.7) 7 (11.9) 1 2 3 ( 3.1) 5 ( 5.2) 4 (10.5) 1 ( 1.7) 1 3 2 ( 2.0) 2 ( 2 . 1 ) 1 ( 2.6) 1 ( 1.7) V4 3 ( 3.1) 2 ( 2.1) 0 ( 0.0) 2 ( 3.4) 15 2 ( 2.0) 2 ( 2.1) 1 ( 2.6) 1 ( 1.7) 1 6 2 ( 2.0) 0 ( 0.0) 0 ( 0.0) 0 ( 0.0) 17 0 ( 0.0) 1 ( 1.0) 0 ( 0.0) 1 ( 1.7) 18 8 ( 8.2) 5 ( 5.2) 4 (10.5) 1 ( 1.7) 34 Tab l e IV (Continued) C r o s s T a b u l a t i o n of Area of Re s i d e n c e and Y e a r ( c o n t i n u e d ) Area Code 1976 1980 1980(LTC) 1980(not LTC) 19 1 ( 1.0) 3 ( 3.1 )• 1 ( 2.6) 2 ( 3.4) 20 5 ( 5.1) 3 ( 3.1) 2 ( 5.3) 1 ( 1.7) 21 3 ( 3.1) 2 ( 2. i ) 0 ( 0.0) 2 •(• 3.4) 22 0 ( 0.0) 1 ( 1.0) 0 ( 0.0) 1 ( 1.7) 23 10 • ( 10.2) 1 3 (13.4) 3. •( 7.9) 1 0 (16.9) 24 1 0 (10.2) 1 ( 1.0) 1 ( 2.6) 0 ( 0.0) 25 1 ( 1 . 0 ) 1 ( 1.0) 0 ( 0.0) 1 ( 1.7) T o t a l 98 97 38 59 S i g n i f i c a n c e T e s t s 1976 v s . 1980 X= 30.24 (df = 24; P = 0.177). 1976 v s . I980(not LTC) V = 31.82 (df = 24; P = 0.132). 1980(LTC) v s . I980(not LTC) 21.53 (df = 23; P = 0.549). 3 5 T a b l e IV (Continued) Biodemographic Data Area Where L i v i n g (Continued) 1 H a s t i n g s / S u n r i s e 14 O a k r i d g e 2 = R e n f r e w / C o l l i n g w o o d 1 5 = Marpole 3 = K i l l a r n e y . 1 6 = Shaughnessy 4 . = Grandview/Woodlands 17 = K e r r i s d a l e 5 = Kensington/Cedar C o t t a g e 18 = K i t s i l a n o 6 V i c t o r i a / F r a s e r v i e w 1 9 = A r b u t u s Ridge 7 = S t r a t h c o n a 20 = Dunbar/Southlands 8 = Mt. P l e a s a n t 21 = West P t . Grey 9 = R i l e y Park 22 = U n i v . End. Lands 1 0 = Sunset 23 = Burnaby 11 = West End 24 = Richmond 1 2 = F a i r v i e w 25 N. Vanc./W. Vane. 1 3 = South Cambie 36 Table V Cross T a b u l a t i o n of Method of R e f e r r a l and Year Method of R e f e r r a l 1976 1980 I980(not LTC) f % f I f % Long Term Care (LTC) 0 .( o. ,0) 39 (43. ,3) C l i e n t / R e l a t i v e of C l i e n t 39 (39. .8) 3 ( 3. ,3) .. ••' 3. ( 5. ,9) Medical S t a f f 23 (23. .5). 1 9 (21 . . 1 ) . 1 9 (37. ,3) S o c i a l S e r v i c e Agency 36 (36. .7) 29 (32. .2) 29 (56. .9) T o t a l 98 90 51 S i g n i f i c a n c e Tests 1976 vs. 1980 % = 70.78 (df = 3; P = 0.000). 1976 vs. I980(not LTC) y^= 19.06 (df = 2; P = 0.000). 37 TABLE VI . Cros s T a b u l a t i o n of Combined P e r s o n a l Care P r a c t i c e and Year C l i e n t r e c e i v e d P e r s o n a l Care 1 976 1980 1980CLTC) I980(not LTC) No Yes 87 (87.0) 58 (58.0) 17 (43.6) 41 (67.2) 13 (13.0) 42 (42.0) 22 (56.4) 20 (32.8) T o t a l 1 00 1 00 39 61 S i g n i f i c a n c e T e s t s 1976 v s . 1980 7-= 21.09 (df = 1 1976 v s . I980 ( n o t LTC) >= 9.103 (df = 1 1980(LTC) v s . I980 ( n o t LTC) yT= 5.450 ( d f = 1 P P P 0.000) 0.003) 0.020) 38 T a b l e V I I Cr o s s T a b u l a t i o n of Combined C h i l d Care P r a c t i c e and Year C l i e n t r e c e i v e d 1976 1980 1980(LTC) 1980(not LTC) C h i l d Care No . 55 (55.0) 81 (81.0) 39 (100.) 42 (68.9) Yes 45 (45.0) 19 ( 19.0): 0 ( 0.0) 19 (31.1) T o t a l 100 100 39 61 . S i g n i f i c a n c e T e s t s 1976 vs. 1980 • %= 15.53 (df 1976 vs. I980(not LTC) j?= 3.036 (df 1980(LTC) vs. I980(not LTC) X*= 15.00 (df = 1; P = 0.000) . = 1; P = 0.082) . = 1; P = 0.000) . 3 9 T a b l e V I I I C r o s s T a b u l a t i o n of Combined Housekeeping P r a c t i c e and Year C l i e n t r e c e i v e d Housekeeping 1 976 1980 1980(LTC) I980(not LTC) No Yes 7 ( 7 . 0 ) 3 ( 3 . 0 ) 3 ( 7 . 7 ) 0 ( 0 . 0 ) 93 (93.0) 97 (97.0) 36 (92.3) 61 (100.) T o t a l 1 00 1 00 39 61 S i g n i f i c a n c e T e s t s 1976 v s . 1980 1.684 (df = 1 1976 v s . I980(not LTC) 4.464 (df = 1 1980(LTC) v s . I980(not LTC) 4.837 (df = 1 P P P 0. 194) 0.035) 0.028) 40 TABLE IX Cr o s s T a b u l a t i o n of Combined P s y c h i a t r i c Problems and Year C l i e n t i n d i c a t e d 1976 1980 1980(LTC) 1980(not LTC) P s y c h i a t r i c Problems No Yes 92 (92.0) 80 (80.0) 36 (92.3) 44 (72.1) 8 ( 8 . 0 ) 20 (20.0) 3 ( 7.7) 17 (27.9) T o t a l 1 00 1 00 39 61 S i g n i f i c a n c e T e s t s 1 976 1 976 v s . 1980 %= 5.980 (df = 1 ; P = v s . I980(not LTC) 1 = 11.40 (df = 1; P = 1980(LTC) v s . I980(not LTC) ?C= 6.053 (df = 1; P = 0.015). 0.001 ) . 0.014). 41 Table X Cros s T a b u l a t i o n of Combined M e d i c a l Problems and Year C l i e n t i n d i c a t e d M e d i c a l Problems 1 976 1980 1980(LTC) I980(not LTC) No Yes 35 (35.0) 20 (20.0) 2 ( 5.1) 1,8 (29.5) 65.(65.0) 80 (80.0) 37 (94.9) 43 (70.5) T o t a l 1 00 1 00 39 61 S i g n i f i c a n c e T e s t s 1976 vs. 1980 X= 5.643 (df = 1; P = 0.018) 1976 vs. I980(not LTC) V= 0.517 (df = 1; P = 0.472) 1980(LTC) vs. I980(not LTC) 8.838 (df = 1; P = 0.003) 42 Tab l e XI C r o s s T a b u l a t i o n of C h i l d Care Problems and Year C l i e n t i n d i c a t e d C h i l d Care Problems 1976 1980 1980(LTC) 1980(not LTC) No Yes 72 (72.0) 28 (28.0) 94 (94.0) 6 ( 6 . 0 ) 39 (100.) 0 ( 0.0) 55 (90.2) 6 ( 9.8) T o t a l 1 00 1 00 39 61 S i g n i f i c a n c e T e s t s 1976 v s . 1980 X= 17.15 (df = 1; P = 0.000) 1976 v s . I980(not LTC) 7.504 (df = 1; P = 0.006) 1980 (LTC)- v s . I980(not LTC) )C= 4.081 (df = 1; P = 0.043) 43 Summary of the S t a t i s t i c a l Data The s t a t i s t i c a l t a b l e s were c o n s t r u c t e d t o r e f l e c t the f o l l o w i n g : biodemographic p r o f i l e s of t y p i c a l c l i e n t s ; the reason s they r e c e i v e d homemaker s e r v i c e ; and what k i n d s of homemaker a s s i s t a n c e were p r o v i d e d t o thes e c l i e n t s . The homemaker p r a c t i c e and c l i e n t d i a g n o s i s c a t e g o r i e s were s t u d i e d i n bo t h i n d i v i d u a l and combined d a t a a n a l y s i s . The i n d i v i d u a l c a t e g o r i e s of po s t - p a r t u m d e p r e s s i o n , p s y c h i a t r i c problem ( u n d i f f e r e n t i a t e d ) , s t r e s s , a l c o h o l i s m , s c h i z o p h r e n i a , and s u i c i d a l t h r o u g h t d i s t u r b a n c e were a l l combined t o c r e a t e the c a t e g o r y of t o t a l p s y c h i a t r i c d i a g n o s i s . The i n d i v i d u a l c a t e g o r i e s of p h y s i c a l h a n d i c a p , a r t h r i t i s , a t home w i t h u n d i f f e r e n t i a t e d i l l n e s s , d i a b e t e s , c a r d i o v a s c u l a r d i s e a s e , s e n i l i t y , l u n g d i s e a s e , and canc e r were a l l combined t o c r e a t e the c a t e g o r y of t o t a l m e d i c a l d i a g n o s e s . The i n d i v i d u a l c a t e g o r i e s of s i c k c h i l d w i t h p a r e n t w o r k i n g , p a r e n t l e s s home, and new baby were combined t o c r e a t e the t o t a l c h i l d c a r e needs d i a g n o s t i c c a t e g o r y . In the second a r e a of c a t e g o r y g r o u p i n g s , i n d i v i d u a l c a t e g o r i e s of u n d i f f e r e n t i a t e d p e r s o n a l c a r e , ambulate, change d r e s s i n g s , h e l p d r e s s , h e l p bathe, monitor h e a l t h , a s s i s t w i t h m e d i c a t i o n , and r e p l a c e Home Care nurse became the t o t a l c a t e g o r y of p e r s o n a l c a r e p r a c t i c e . Care f o r c h i l d r e n e x i s t e d both as an i n d i v i d u a l as w e l l as a t o t a l p r a c t i c e c a t e g o r y . I n d i v i d u a l c a t e g o r i e s of home c a r e ( u n d i f f e r e n t i a t e d ) , c l e a n , do l a u n d r y , p r e p a r e meals, and shop were combined f o r the t o t a l p r a c t i c e c a t e g o r y of housekeeping p r a c t i c e . I n d i v i d u a l sub-c a t e g o r i e s were t a b u l a t e d f o r the y e a r s 1976 and 1980. The 44 combined c a t e g o r i e s were t a b u l a t e d f o r 1976 v s . 1980 ( t o t a l ) ; 1976 v s . 1980 ( e x c l u d i n g a l l LTC c l i e n t s ) ; and 1980 (LTC c l i e n t s ) v s . 1980 (non-LTC c l i e n t s ) . The d e c i s i o n t o combine the i n d i v i d u a l c a t e g o r i e s i n t o combined, t a b u l a t e d c a t e g o r i e s was based on the f i n d i n g t h a t most of the i n d i v i d u a l c a t e g o r i e s were not s t a t i s t i c a l l y s i g n i f i c a n t , and i n some ca s e s were o v e r l a p p i n g . I n d i v i d u a l C a t e g o r i e s of P r a c t i c e The i n d i v i d u a l c a t e g o r i e s of the o v e r a l l p r a c t i c e c a t e g o r y d i s p l a y e d the f o l l o w i n g t r e n d s . Areas i n which t h e r e was an i n c r e a s e i n p a r t i c u l a r s e r v i c e s b e i n g r e c e i v e d by c l i e n t s were: a s s i s t a n c e w i t h u n d i f f e r e n t i a t e d p e r s o n a l c a r e ; r e p l a c i n g the home c a r e nurse t e m p o r a r i l y ; c l e a n i n g ; p r e p a r i n g meals; and shopp i n g . Decreases o c c u r r e d i n the areas o f : a s s i s t i n g w i t h d r e s s i n g changes; c a r i n g f o r c h i l d r e n ; d o i n g l a u n d r y ; and housekeeping ( u n d i f f e r e n t i a t e d ) . New c a t e g o r i e s were c r e a t e d i n 1980 t h a t d i d not e x i s t i n 1976. These were: m o n i t o r i n g the c l i e n t ' s h e a l t h s t a t u s (e.g. noted changes i n v i t a l s i g n s ) ; a s s i s t i n g w i t h m e d i c a t i o n s ( e.g. g i v i n g prepoured m e d i c a t i o n t o the c l i e n t ) ; h e l p i n g t o ambulate; d r e s s ; and bathe. I n d i v i d u a l C a t e g o r i e s of D i a g n o s i s In the a r e a of i n d i v i d u a l c l i e n t d i a g n o s i s , the a r e a t h a t r e f e r s s p e c i f i c a l l y t o the problems the c l i e n t e x p e r i e n c e d as a p r e c u r s o r t o needing homemaker a s s i s t a n c e , the f o l l o w i n g t r e n d s were o b s e r v e d . I n c r e a s e s o c c u r r e d i n 1980 w i t h i n the c l i e n t d i a g n o s t i c c a t e g o r i e s o f : u n d i f f e r e n t i a t e d p s y c h i a t r i c problems; 45 alcoholism; physical handicap; at home with undiagnosed i l l n e s s ; diabetic condition; cardiovascular disease; and cancer. Decreases occurred in the areas of: stress syndrome; a r t h r i t i s ; s e n i l i t y ; lung disease; sick c h i l d with parent working; parentless home; and new baby. The individual categories, while displaying interesting trends in practice and diagnosis, cannot be construed as being s t a t i s t i c a l l y s i g n i f i c a n t . Given the diverse spread of categories, a decision was made to combine the individual subsets of diagnosis arid practice into the more s t a t i s t i c a l l y accurate groupings of: t o t a l personal care practice, t o t a l c h i l d care practice, t o t a l housekeeping practice, t o t a l psychiatric diagnosis, t o t a l medical diagnosis, and t o t a l c h i l d care needs diagnosis. These s p e c i f i c , individual categories do not appear as such within the tabular form of the preceding s t a t i s t i c a l tables. 46 Q u a n t i t a t i v e Statements C o n c e r n i n g T a b l e s I - XI T a b l e I - Sex of C l i e n t The homemaker c l i e n t s i n t h i s study were shown t o be p r e d o m i n a t e l y female i n both y e a r s ; 87.9 % i n 1976; 79.0 % i n 1980. T a b l e I I - Age of C l i e n t The c l i e n t of 1980 a l s o i n c r e a s e d i n age w i t h a s i g n i f i c a n t i n c r e a s e o c c u r r i n g i n those 80-90 y e a r s : 9.8% i n 1976 compared t o 25.9% i n 1980. 47.2% of the LTC c l i e n t s were aged 80 - 90 y e a r s . There was a c o r r e s p o n d i n g decrease i n 1980 of c l i e n t s under the age of f o u r t y . T a b l e I I I - Number i n F a m i l y U n i t The c l i e n t of 1980 r e p r e s e n t e d a s m a l l e r f a m i l y u n i t . LTC c l i e n t s were e s p e c i a l l y r e p r e s e n t a t i v e of d e c r e a s e d f a m i l y u n i t s , w i t h 68.4% l i v i n g a l o n e . T a b l e IV - Area of R e s i d e n c e The m a j o r i t y of c l i e n t s i n both y e a r s were C i t y of Vancouver r e s i d e n t s . By 1980 t h e r e was a r i s e i n c l i e n t r e s i d e n c y i n the West End; i n c r e a s i n g from 11.2% i n 1976 t o 16.5% i n 1980. T a b l e V - Method of R e f e r r a l I t i s i m p o r t a n t t o note t h a t the Long Term Care (LTC) d i v i s i o n of t h e M i n i s t r y of H e a l t h d i d not e x i s t i n 1976. By 47 1980, f o l l o w i n g the c r e a t i o n of t h i s LTC d i v i s i o n i n 1978, 43.3% of a l l c l i e n t s t o t h i s homemaker agency were b e i n g r e f e r r e d by LTC. In 1976, 39.8% of a l l c l i e n t s were r e f e r r e d by the c l i e n t or the c l i e n t ' s r e l a t i v e ; by 1980 t h i s r e f e r r a l mode had dec r e a s e d t o o n l y 3.3%. T a b l e s VI th r o u g h V I I I - Combined P r a c t i c e C a t e g o r i e s When the above i n d i v i d u a l c a t e g o r i e s were combined f o r o v e r a l l a n a l y s i s , the f o l l o w i n g p i c t u r e of homemaker p r a c t i c e appeared. T o t a l p e r s o n a l c a r e p r a c t i c e i n c r e a s e d from 13.0% i n 1976 t o 42.0% i n 1980. In 1980.56.4% of those r e c e i v i n g p e r s o n a l c a r e a s s i s t a n c e were.LTC c l i e n t s . T o t a l c h i l d c a r e p r a c t i c e d e c r e a s e d from 45.0% i n 1976 t o 19.0% i n 1980, w i t h no LTC c l i e n t s r e c e i v i n g " t h i s s e r v i c e . T o t a l housekeeping p r a c t i c e d i s p l a y e d no s i g n i f i c a n t d i f f e r e n t i a t i o n i n the pe r c e n t a g e of c l i e n t s r e c e i v i n g t h i s s e r v i c e i n e i t h e r y e a r , w i t h 93.0% of the c l i e n t s i n 1976 r e c e i v i n g housekeeping a s s i s t a n c e , 97.0% i n 1980. 92.3% c l i e n t s r e c e i v e d housekeeping s e r v i c e were LTC c l i e n t s ; 100% of the non-LTC c l i e n t s had h e l p w i t h t h e i r housework. T a b l e s IX t h r o u g h XI - Combined D i a g n o s i s C a t e g o r i e s The combined c a t e g o r y of d i a g n o s e s p r e s e n t s the f o l l o w i n g i n f o r m a t i o n about the homemaker c l i e n t . T o t a l p s y c h i a t r i c d i a g n o s e s i n c r e a s e d from 8.0% of the c l i e n t s i n 1976 t o 20.0% i n 1980. In 1980 t h e r e were 27.9% of the non-LTC c l i e n t s i n t h i s c a t e g o r y , as opposed t o 7.7% i n the same y e a r . T o t a l m e d i c a l d i a g n o s e s i n c r e a s e d from 65.0% i n 1976 t o 80.0% i n 1980. A 48 h i g h e r p e r c e n t a g e of LTC c l i e n t s had a m e d i c a l d i a g n o s i s problem, w i t h 94.9% of a l l LTC c l i e n t s h a v i n g a m e d i c a l d i a g n o s i s as opposed t o 70.5% of the non-LTC c l i e n t s . In t o t a l c h i l d c a r e problems a decrease o c c u r r e d w i t h 28.0% of 1976 c l i e n t s i n t h i s c a t e g o r y , w h i l e 6.0% had t h i s problem i n 1980. The Provus D i s c r e p a n c y Model A p p l i e d t o Homemakers The Provus D i s c r e p a n c y Model (see Table X I I ) p r e s e n t s a . d e t a i l e d , m u l t i - s t a g e a n a l y s i s of the l e v e l of congruency or d i s c r e p a n c y t h a t appears t o e x i s t between what the homemaker i n t h i s agency p r a c t i c e d and the t h e o r y t h a t a m a j o r i t y of these homemakers had been t a u g h t . The c u r r i c u l u m of the V.C.C. program t h a t was used i n the d i s c r e p a n c y e v a l u a t i o n c o n t a i n s a s e r i e s of seven t r a c k s of, t e a c h i n g and s t u d e n t a c t i v i t i e s . They a r e : Track A ( O r i e n t a t i o n t o Employment M a r k e t ) , Track B ( O r i e n t a t i o n t o O c c u p a t i o n a l Role a n d . F u n c t i o n ) , Track C ( P r o t e c t i o n i n the Home), Track D ( N u t r i t i o n ) , Track E (Growth and Development), Track F (Communications), and Track G ( H e a l t h ) . In p r e p a r i n g the d a t a f o r t h i s d i s c r e p a n c y e v a l u a t i o n phase, the t o t a l c u r r i c u l u m of the program was a n a l y z e d f o r c o m p a r a t i v e purposes w i t h the s t a t i s t i c a l p r a c t i c e c a t e g o r i e s . The w r i t e r ' s i n t e n t was t o determine where and t o what e x t e n t a p a r t i c u l a r homemaker p r a c t i c e appeared t o have been taught w i t h i n the homemaker t r a i n i n g program, 1980 f o r m a t . In a l l c a t e g o r i e s i t was p o s s i b l e t o a s c e r t a i n t h e s e c u r r i c u l a r d e t a i l s , w i t h the e x c e p t i o n of the Homemaker P r a c t i c e C a t e g o r y 4 9 7.0: Care f o r C h i l d r e n , Stage 111, s u b s e t , s t u d e n t g u i d e l i n e s as to hours of t e a c h i n g / a c t i v i t y s p e c i f i c a l l y r e l a t e d t o t h i s p r a c t i c e a l o n e . T h i s c a t e g o r y p r e s e n t e d a u n i q u e l y d i f f i c u l t a r e a f o r r e s e a r c h i n g a l l the p o s s i b l e t r a c k s and t h e i r sub s p e c i a l i t i e s of t e a c h i n g and a c t i v i t y t h a t c o u l d be r e l a t e d t o t h i s p r a c t i c e c a t e g o r y . The reason f o r t h i s d i f f i c u l t y a r ose from the f a c t t h a t c h i l d c a r e t r a i n i n g i s subsumed under the t r a c k s of C, D, E, F, and G. S u b s e q u e n t l y , t h i s one subset of Stage I I I does not i n d i c a t e the amount of a c t u a l t e a c h i n g / p r a c t i c e time a l l o t e d i n the c u r r i c u l u m o u t l i n e f o r the homemaker c o u r s e . I t i s , however, obv i o u s t h a t Stages I through Stage IV i n d i c a t e e x t e n s i v e congruence i n t h i s a r e a of p r a c t i c e . The o v e r a l l r e s u l t s of the Provus D i s c r e p e n c y Model i n d i c a t e t h a t a s i g n i f i c a n t degree of congruence o c c u r r e d between the t h e o r y and the p r a c t i c e of the homemaker group. The a r e a s of d i s c r e p a n c y , as noted w i t h i n the Provus model, and the apparent reasons f o r t h e i r e x c l u s i o n from the V.C.C. homemaker c u r r i c u l u m w i l l be a d d r e s s e d i n d e t a i l i n the c o n c l u d i n g c h a p t e r . 50 Tab l e X I I Homemaker P r a c t i c e C ategory 1.0 Ambulate C l i e n t Stage I T e r m i n a l G o a l : I n t e r i m O b j e c t i v e s : Track G. " A s s i s t c h i l d r e n and a d u l t s t o m a i n t a i n t h e i r a c t i v i t i e s of d a i l y l i v i n g . " G. I . "Demonstrate acceptance of the homemaker's r o l e i n . r e l a t i o n t o s u p e r v i s i n g h e a l t h . p e r s o n n e l and r e s p o n s i b i l i t i e s a p p r o p r i a t e t o the homemakers i n the d e l i v e r y of h e a l t h c a r e . " G. I I . " A s s i s t c h i l d r e n and ambulato r y a d u l t s w i t h a s t a b i l i z e d c a r e p l a n t o meet t h e i r needs f o r p e r s o n a l c a r e under the p r e s c r i p t i o n and s u p e r v i s i o n of the h e a l t h c a r e team." G. I I . 3.0 " A s s i s t i n f a n t s , c h i l d r e n and a d u l t s t o m a i n t a i n the l e v e l of e x e r c i s e and a c t i v i t y p r e s c r i b e d t o meet i n d i v i d u a l needs." • Stage I I Stage I I I V.C.C. C u r r i c u l u m i n d i c a t e s s t u d e n t w i l l be a b l e t o a s s i s t c l i e n t i n the f o l l o w i n g a r e a s (examples g i v e n ) : Homemaker p r a c t i c e i n d i c a t e s 5% of the c l i e n t s i n 1980 r e c e i v e d s e r v i c e . V.C.C. C u r r i c u l u m i n d i c a t e s T e r m i n a l G o a l G. and I n t e r i m O b j e c t i v e s G.I., G . I I . , G.II.3.0 r e l a t e d t o P r a c t i c e Category 1.0. " T r a n s f e r r i n g a c l i e n t from the bed t o v a r i o u s s i t t i n g p o s i t i o n s i n a c h a i r , w h e e l c h a i r , t o i l e t , t u b , or c h a i r . " " A s s i s t a c l i e n t t o walk w i t h m e c h a n i c a l a i d s , such a s , canes, c r u t c h e s , w a l k e r s , or w i t h o u t a i d s . " S t u d e n t s G u i d e l i n e s i n d i c a t e a minimum of 60 minutes independent a c t i v i t y , 30 minutes whole group a c t i v i t y , and a home assignment r e l a t e d t o a m b u l a t i o n . Stage IV Data i n d i c a t e s . congruence i n p r a c t i c e category. 52 Tab l e X I I ( c o n t i n u e d )  Homemaker P r a c t i c e Category 2.0 H e l p Dress Stage I T e r m i n a l G o a l : I n t e r i m O b j e c t i v e s : Track G. " A s s i s t c h i l d r e n and a d u l t s t o m a i n t a i n t h e i r a c t i v i t i e s of d a i l y l i v i n g . " G. I . "Demonstrate acceptance of the homemaker's r o l e i n r e l a t i o n t o s u p e r v i s i n g h e a l t h p e r s o n n e l and r e s p o n s i b i l i t i e s a p p r o p r i a t e t o the homemakers i n the d e l i v e r y of h e a l t h c a r e . " G. I I . " A s s i s t c h i l d r e n and ambulatory a d u l t s w i t h a s t a b i l i z e d c a r e p l a n t o meet t h e i r needs f o r p e r s o n a l c a r e under the p r e s c r i p t i o n and s u p e r v i s i o n of the h e a l t h c a r e team." G. I I . 1.2 " P r o v i d e the a s s i s t a n c e r e q u i r e d by the i n f a n t , the c h i l d , the t e m p o r a r i l y i n c a p i c i t a t e d a d u l t and the e l d e r l y person who has moderate l i m i t a t i o n s i n c a r r y i n g out p e r s o n a l h y g i e n e . " Stage I I Homemaker p r a c t i c e d a t a i n d i c a t e s 4% of the c l i e n t s i n 1980 r e c e i v e d s e r v i c e . V.C.C. C u r r i c u l u m i n d i c a t e s t e r m i n a l g o a l G.; i n t e r i m o b j e c t i v e s G.I., G . I I . , G.II.1.2 r e l a t e d t o p r a c t i c e c a t e g o r y 2.0. Stage I I I V.C.C. C u r r i c u l u m i n d i c a t e s s t u d e n t w i l l be a b l e t o a s s i s t c l i e n t i n the f o l l o w i n g a r e a s (examples g i v e n ) : " P r o v i d i n g n e a t , c l e a n c l o t h i n g and bedding." S t u d e n t s G u i d e l i n e s i n d i c a t e a minimum of 60 minutes group a c t i v i t y , i n c l u d i n g f i l m s t r i p and r e s o u r c e sheet f o r s t u d e n t s r e l a t e d t o p e r s o n a l c a r e i n l o n g - t e r m i l l n e s s e s . Stage IV Data indicates congruence in practice category. 54 T a b l e X I I ( c o n t i n u e d )  Homemaker P r a c t i c e Category 3.0 Help Bathe Stage I T e r m i n a l g o a l : Track G. " A s s i s t c h i l d r e n and a d u l t s t o m a i n t a i n t h e i r a c t i v i t i e s of d a i l y l i v i n g . " I n t e r i m O b j e c t i v e s : G. I . "Demonstrate acceptance of the homemaker's r o l e i n r e l a t i o n t o s u p e r v i s i n g h e a l t h p e r s o n n e l and r e s p o n s i b i l i t i e s a p p r o p r i a t e t o the homemakers i n the d e l i v e r y of h e a l t h c a r e . " G. I I . " A s s i s t c h i l d r e n and ambulatory a d u l t s w i t h a s t a b i l i z e d c a r e p l a n t o meet t h e i r needs f o r p e r s o n a l c a r e under the p r e s c r i p t i o n and s u p e r v i s i o n of the h e a l t h c a r e team." G. I I . 1.2.1 " P r o v i d e the a s s i s t a n c e r e q u i r e d by the i n f a n t , the c h i l d , the t e m p o r a r i l y i n c a p i c i t a t e d a d u l t and the e l d e r l y person who has moderate l i m i t a t i o n s i n meeting needs f o r b a t h i n g and eye c a r e . " Stage I I Homemaker p r a c t i c e d a t a i n d i c a t e s 19% of the c l i e n t s i n 1980 r e c e i v e d s e r v i c e . V.C.C. C u r r i c u l u m i n d i c a t e s t e r m i n a l g o a l G., i n t e r i m o b j e c t i v e s G.I., G . I I . , G.II.1.2.1 r e l a t e d t o p r a c t i c e c a t e g o r y 3.0. Stage I I I V.C.C. C u r r i c u l u m i n d i c a t e s s t u d e n t w i l l be a b l e t o a s s i s t c l i e n t i n the f o l l o w i n g a r e a s (examples g i v e n ) : " P r o v i d i n g a s s i s t a n c e w i t h bed b a t h s , baby b a t h s , showers and tub b a t h s . " Student G u i d e l i n e s i n d i c a t e a minimum of 4 hours g r o u p / i n d i v i d u a l a c t i v i t i e s , p o s t - t e s t i n g ; use of f i l m s t r i p and r e s o u r c e s h e e t s r e l a t e d t o b a t h i n g a s s i s t a n c e . Stage I V Data i n d i c a t e s congruence i n p r a c t i c e category. 5 6 T a b l e X I I ( c o n t i n u e d )  Homemaker P r a c t i c e Category 4.0 M o n i t o r H e a l t h S t a t e Stage I T e r m i n a l G o a l : No t e r m i n a l g o a l / i n t e r i m o b j e c t i v e I n t e r i m O b j e c t i v e : . r e l a t e d t o p r a c t i c e c a t e g o r y . Stage I I Homemaker p r a c t i c e data i n d i c a t e s 7% of the c l i e n t s i n 1980 r e c e i v e d s e r v i c e . V.C.C. C u r r i c u l u m i n d i c a t e s no t e r m i n a l g o a l / i n t e r i m o b j e c t i v e r e l a t e d t o p r a c t i c e c a t a g o r y . Stage I I I V.C.C. C u r r i c u l u m i n d i c a t e s no i n t e r i m p r o d u c t s r e l a t e d t o p r a c t i c e . Stage IV . Data i n d i c a t e s l a c k of congruence i n p r a c t i c e c a t e g o r y . 57 Table X I I ( c o n t i n u e d )  Homemaker P r a c t i c e Category 5.0 A s s i s t With M e d i c a t i o n Stage I T e r m i n a l G o a l : No t e r m i n a l g o a l / i n t e r i m o b j e c t i v e I n t e r i m O b j e c t i v e : r e l a t e d t o p r a c t i c e c a t e g o r y . Stage I I Homemaker p r a c t i c e d a t a i n d i c a t e s 2% of the c l i e n t s i n 1980 r e c e i v e d s e r v i c e . V.C.C. C u r r i c u l u m i n d i c a t e s no t e r m i n a l g o a l / i n t e r i m o b j e c t i v e r e l a t e d t o p r a c t i c e c a t a g o r y . Stage I I I V.C.C. C u r r i c u l u m i n d i c a t e s no i n t e r i m p r o d u c t s r e l a t e d t o p r a c t i c e . Stage IV Data i n d i c a t e s l a c k of congruence i n p r a c t i c e c a t e g o r y . 58 Table X I I ( c o n t i n u e d )  Homemaker P r a c t i c e C a t e g o r y 6.0 Replace Homecare Nurse T e m p o r a r i l y Stage I T e r m i n a l G o a l : No t e r m i n a l g o a l / i n t e r i m o b j e c t i v e I n t e r i m O b j e c t i v e : r e l a t e d t o p r a c t i c e c a t e g o r y . Stage I I Homemaker p r a c t i c e d a t a i n d i c a t e s 4% of the c l i e n t s i n 1980 r e c e i v e d s e r v i c e . V.C.C. C u r r i c u l u m i n d i c a t e s no t e r m i n a l g o a l / i n t e r i m o b j e c t i v e r e l a t e d t o p r a c t i c e c a t a g o r y . Stage I I I . V.C.C. C u r r i c u l u m i n d i c a t e s no i n t e r i m p r o d u c t s r e l a t e d t o p r a c t i c e . Stage IV Data i n d i c a t e s l a c k of congruence i n p r a c t i c e c a t e g o r y . 59 Table X I I ( c o n t i n u e d )  Homemaker P r a c t i c e Category 7.0 Care f o r C h i l d r e n Stage I T e r m i n a l G o a l : Track E. "Work w i t h c h i l d r e n and a d u l t s a t v a r i o u s s t a t e s of growth and development." Track G. '-"Assist ' c h i l d r e n , and a d u l t s t o m a i n t a i n t h e i r a c t i v i t i e s of d a i l y l i v i n g . " I n t e r i m O b j e c t i v e s : E. I . "Understand the common c u l t u r a l , e m o t i o n a l , and b i o l o g i c a l needs of an i n d i v i d u a l a r i s i n g from h i s age ( s t a g e of growth and development), l i f e s t y l e and f a m i l y s i t u a t i o n . " E. I I . "Demonstrate a h e l p i n g response t o g i v e n i n d i v i d u a l s and f a m i l i e s c o n s i s t e n t w i t h t h e i r b a s i c human needs and s p e c i a l needs f o r growth and development." G. I . "Demonstrate a c c e p t a n c e of the homemaker's r o l e i n r e l a t i o n t o s u p e r v i s i n g h e a l t h p e r s o n n e l and r e s p o n s i b i l i t i e s a p p r o p r i a t e t o the homemakers i n the d e l i v e r y of h e a l t h c a r e . " G. I I . " A s s i s t c h i l d r e n and ambulatory a d u l t s w i t h a s t a b i l i z e d c a r e p l a n t o meet t h e i r needs f o r p e r s o n a l c a r e under the p r e s c r i p t i o n and s u p e r v i s i o n of the h e a l t h c a r e team. " G. I I . 1.0 " A s s i s t i n m a i n t a i n i n g h e a l t h y f u n c t i o n of the s k i n and mucuous membranes ..." G. I I . 2.0 " A s s i s t i n p r o v i d i n g c o n d i t i o n s which promote r e s t and s l e e p f o r i n f a n t s , c h i l d r e n and a d u l t s . " G. I I . 3.0 " A s s i s t i n f a n t s , c h i l d r e n and a d u l t s t o m a i n t a i n the l e v e l of e x e r c i s e and a c t i v i t y p r e s c r i b e d t o meet i n d i v i d u a l needs." G. I I . 4.0 " A s s i s t an i n d i v i d u a l t o meet h i s normal needs f o r e l i m i n a t i o n from bowel, b l a d d e r , s k i n and l u n g s . 60 G. I I . 5.0 " A s s i s t i n f a n t s , c h i l d r e n and m o d e r a t e l y i n c a p a c i t a t e d a d u l t s w i t h f e e d i n g . " G. I I . 6.0 " A s s i s t i n s u p p o r t i n g an i n d i v i d u a l and a f a m i l y t o meet t h e i r needs f o r s e c u r i t y i n approved and/or p r e s c r i b e d ways." G. I I I . "Promote independence i n her c l i e n t s r e g a r d i n g a c t i v i t i e s of d a i l y l i v i n g . " Stage I I Homemaker p r a c t i c e d a t a i n d i c a t e s 19% of the c l i e n t s i n 1980 r e c e i v e d s e r v i c e . V.C.C. C u r r i c u l u m i n d i c a t e s T e r m i n a l G o a l s E and G; and I n t e r i m O b j e c t i v e s E . I . , E . I I . , G.I., G . I I . , G . I I . 1 . 0 , G.II.2.0, G.II.3.0, G.I I.4.0, G.II.5.0, G.II.6.0, and G . I I I . r e l a t e d t o P r a c t i c e C ategory 8.0. Stage I I I V.C.C. C u r r i c u l u m i n d i c a t e s s t u d e n t w i l l be a b l e t o a s s i s t c l i e n t i n the f o l l o w i n g a r e a s (examples g i v e n ) : " P e r f o r m i n g the s p e c i f i c s k i l l s of baby b a t h s , b a t h i n g a c h i l d c o n f i n e d t o bed, d i a p e r i n g an i n f a n t , b o t t l e f e e d i n g i n f a n t s , p r o v i d i n g f e e d i n g r e q u i r e d by i n f a n t s and t o d d l e r s . " Student G u i d e l i n e s i n d i c a t e e x t e n s i v e i n d i v i d u a l / g r o u p a c t i v i t i e s , f i l m s t r i p s and d i s c u s s i o n r e l a t e d t o c a r e f o r c h i l d r e n . P r a c t i c e C ategory 7.0 i s an example of an i n t e g r a t e d c a t e g o r y , i n v o l v i n g Track C ( P r o t e c t i o n i n the Home), Track D ( N u t r i t i o n ) , Track E (Growth and Development), Track F (Communication), and Track G ( H e a l t h ) . Stage IV Data i n d i c a t e s congruence i n p r a c t i c e c a t e g o r y . 6 1 Table X I I ( c o n t i n u e d )  Homemaker P r a c t i c e C a t e g o r i e s 8.0 Clean, and 9.0 Do Laundry Stage I T e r m i n a l G o a l : I n t e r i m O b j e c t i v e s : Track C. "Meet needs f o r p r o t e c t i o n i n the home." C. V. "Know approved methods f o r c o n t r o l l i n g common hazards t o s a n i t a t i o n i n the home." C. V I . 1.0 "Know b a s i c p r i n c i p l e s u n d e r l y i n g home c l e a n i n g and maintenance." C. V I . 1.2 " D e s c r i b e the major p r i n c i p l e s i n v o l v e d i n home c l e a n i n g . " C. V I . 2.0 " L i s t - common pro c e d u r e s i n v o l v e d i n a home c l e a n i n g p l a n . " V I . 3.0 "Know the b a s i c s of l a u n d e r i n g . " C. C. c . c . c . c . c . c . c . c . c . c . c . 4.0 "Do l a u n d r y . " 5.0 "Use, c l e a n , and m a i n t a i n r e f r i g e r a t o r - f r e e z e r . " 6.0 "Use, c l e a n , a n d . m a i n t a i n k i t c h e n range." 7.0 "Use, c l e a n , and m a i n t a i n d i s h w a s h e r . " 8.0 " P r o v i d e f l o o r c a r e . " 9.0 " P r o v i d e rug and c a r p e t "Care f o r w a l l s and "Care f o r f u r n i t u r e , and m i r r o r s . " "Use, c l e a n , and c l e a n i n g t o o l s . " "Clean the bathroom." "Use, c l e a n , and c l e a n i n g t o o l s . " "Given a s p e c i f i c f a m i l y s i t u a t i o n , use a home and maintenance p l a n . " VI VI a VI a VI a VI VI c a r e . " V I . 10.0 woodwork VI . 11.0 windows, VI . 12.0 m a i n t a i n V I . 13.0 V I . 14.0 m a i n t a i n V I . 15.0 and home c l e a n i n g 62 Stage 11 Homemaker p r a c t i c e d a t a i n d i c a t e s 52% of the c l i e n t s i n 1980 r e c e i v e d s e r v i c e i n P r a c t i c e 8.0; and 27% r e c e i v e d s e r v i c e i n P r a c t i c e 9.0. V.C . C . C u r r i c u l u m i n d i c a t e s T e r m i n a l Goal C. and I n t e r i m O b j e c t i v e s C.V. and C.VI.1.0 t o C.VI.15.0 a r e r e l a t e d t o P r a c t i c e C a t e g o r i e s 8.0 and 9.0. Stage I I I V.C.C. C u r r i c u l u m i n d i c a t e s s t u d e n t w i l l be a b l e t o "Do l a u n d r y and c l e a n . " a s s i s t c l i e n t i n the f o l l o w i n g a r e a s (examples g i v e n ) : Student g u i d e l i n e s i n d i c a t e a minimum of 56 hours and 30 minutes of independent/group a c t i v i t y , p o s t -t e s t i n g , and f i e l d a s s i g n m e n t s . Stage IV Data i n d i c a t e s congruence i n p r a c t i c e c a t e g o r i e s . 63 T a b l e X I I ( c o n t i n u e d )  Homemaker P r a c t i c e Category 10.0 P r e p a r e Meals and 11.0 -Shop f o r G r o c e r i e s Stage I T e r m i n a l G o a l : Track D. "Meet needs for. n u t r i t i o n , i n the home." I n t e r i m O b j e c t i v e s : D. I . " I d e n t i f y b a s i c n u t r i t i o n a l needs of an i n d i v i d u a l and a f a m i l y . " D. I I . I d e n t i f y the major i n f l u e n c e s which a f f e c t how an i n d i v i d u a l and/or f a m i l y meets t h e i r n u t r i t i o n a l needs. D. I I I . " O u t l i n e meal p l a n s to meet the n u t r i t i o n a l needs of an i n d i v i d u a l or f a m i l y i n g i v e n f i e l d s i t u a t i o n s . " D. IV. "Demonstrate approved ways of meeting n u t r i t i o n a l needs of a i n d i v i d u a l or f a m i l y . " D. V. " E v a l u a t e the c o n t i n u i n g e f f e c t i v e n e s s of the n u t r i t i o n a l p l a n f o r an i n d i v i d u a l and/or f a m i l y . " D. V I . "Demonstrate a p e r s o n a l committment t o the p u r s u i t of adequate n u t r i t i o n f o r h e r s e l f and her c l i e n t s . " Stage I I Homemaker p r a c t i c e d a t a i n d i c a t e s 28% of t h e c l i e n t s i n 1980 r e c e i v e d s e r v i c e i n p r a c t i c e c a t e g o r y 10.0; and 32% r e c e i v e d s e r v i c e i n p r a c t i c e c a t e g o r y 11.0. V.C.C. C u r r i c u l u m i n d i c a t e s T e r m i n a l G o a l D. and I n t e r i m O b j e c t i v e s D.I. t o D.VI. a r e r e l a t e d t o P r a c t i c e C a t e g o r i e s 10.0 and 11.0. 6 4 Stage I I I V.C.C. C u r r i c u l u m i n d i c a t e s s t u d e n t w i l l be a b l e t o a s s i s t c l i e n t i n the f o l l o w i n g a r e a s (examples g i v e n ) : " Organize and implement d a i l y and weekly meal p l a n s . " "Purchase food a c c o r d i n g t o a food p l a n . " "Prepare food f o r c l i e n t consumption." Student g u i d e l i n e s i n d i c a t e a minimum of 33 hours of independent a c t i v i t i e s , whole group and s m a l l group a c t i v i t i e s , f i l m s , l e c t u r e s and d i s c u s s i o n s . Stage IV Data i n d i c a t e s congruence i n p r a c t i c e c a t e g o r i e s . 65 L i m i t a t i o n s of the Study I t has been the i n t e n t of the w r i t e r t o d e s c r i b e w i t h some d e t a i l the r o l e , t h e o r y and p r a c t i c e of a p a r t i c u l a r homemaker group from the lower mainland of B r i t i s h Columbia. The r e s e a r c h b o u n d a r i e s w i t h i n t h i s t h e s i s were d e l i b e r a t e l y l i m i t e d i n o r d e r t o d e s c r i b e w i t h some depth and p r e c i s i o n a s p e c i f i c body of homemakers.. As a r e s u l t , i t may not be p o s s i b l e t o g e n e r a l i z e the r e s u l t s of t h i s t h e s i s . The e v a l u a t i v e mode was chosen as a way of p r o v i d i n g i n d e t a i l the homemaker's t h e o r y and p r a c t i c e . The s o c i o l o g i c a l u n d e r p i n n i n g t h a t p r o v i d e s a c o n t e x t u a l framework f o r t h i s t h e s i s i s p r e s e n t e d as an e s s e n t i a l f o u n d a t i o n on which our u n d e r s t a n d i n g s of the homemaker's r o l e , t h e o r y , and p r a c t i c e can be based. In f u r t h e r o u t l i n i n g the l i m i t a t i o n s of t h i s t h e s i s the w r i t e r wishes t o p o i n t out c e r t a i n a r e a s of the t h e o r y and p r a c t i c e d a t a t h a t have been a c c e p t e d as u n t e s t e d . For example, t h e r e may be a d d i t i o n a l a r e a s of d i s c r e p a n c y i n v o l v i n g the ex a c t number of hours t h a t a c t u a l l y go i n t o the o v e r a l l p r o c e s s of homemaker t r a i n i n g . F u r t h e r m o r e , the c l i e n t f i l e s i n d i c a t e o n l y nominal a r e a s of p r a c t i c e . The ex a c t measurement of the a c t u a l hours of a l l p r a c t i c e w i t h i n a g i v e n c l i e n t ' s home has y e t t o be det e r m i n e d . The l i m i t a t i o n s of t h i s t h e s i s a r e p r o v i d e d i n or d e r t o c l a r i f y as w e l l as t o suggest f u r t h e r r e s e a r c h i n t h i s a r e a . A p a r t i c i p a n t o b s e r v e r mode of i n q u i r y c o u l d be most u s e f u l i n i l l u m i n a t i n g t h e s e q u e s t i o n s . T h i s c h a p t e r has p r e s e n t e d a l l the d a t a a n a l y s e s except the i n t e r v i e w f i n d i n g s . The i n t e r v i e w f i n d i n g s a r e i n c l u d e d w i t h 66 the o v e r a l l d i s c u s s i o n of the homemaker r o l e , t h e o r y , and . p r a c t i c e t h a t w i l l appear i n Chapter V I . 67 Chapter VI  DISCUSSION AND RECOMMENDATIONS Change and I t s I m p l i c a t i o n s Whereas, the c l i e n t i n 1980 d i f f e r s s i g n i f i c a n t l y from her 1976 c o u n t e r p a r t , i t cannot be argued t h a t t h i s change i s s o l e l y due t o the c r e a t i o n of Long Term Care i n 1978. C l i e n t s w i t h p e r s o n a l c a r e needs i n 1980 who were not a s s o c i a t e d w i t h LTC i n c r e a s e d s i g n i f i c a n t l y . The same i s t r u e f o r non-LTC c l i e n t s i n 1980 who e x p e r i e n c e d p s y c h i a t r i c as w e l l as m e d i c a l problems. Viewed as a whole, the homemaker s i t u a t i o n appears t o d i s p l a y a number of i n h e r e n t problems. The i n f e r e n c e s t h a t can be drawn from the r e s e a r c h a re r e l a t e d s p e c i f i c a l l y t o the r o l e , t h e o r y , and p r a c t i c e of the homemaker as i t a f f e c t e d both the LTC and the non-LTC c l i e n t . The o v e r a l l f i n d i n g s i n t h i s a r e a were t h a t the r o l e of the homemaker has changed s i g n i f i c a n t l y between 1976 and 1980. The homemaker appears t o have been p l a c e d i n a s i t u a t i o n i n which i n c r e a s i n g demands are b e i n g p l a c e d on her c a p a c i t y t o meet the r a p i d l y c h a n g i n g needs of her c l i e n t . Not o n l y i s her c l i e n t o l d e r , h a v i n g a n o t a b l e degree of m e d i c a l and p s y c h i a t r i c problems t h a t o f t e n n e c e s s i t a t e a m y r i a d a r r a y of complex h e a l t h c a r e s e r v i c e s , but t h i s same c l i e n t i s p a r t of s m a l l e r f a m i l y u n i t and may be more s o c i a l l y i s o l a t e d than was her 1976 c o u n t e r p a r t . 68 R o l e of the Homemaker as the "Good S a m a r i t a n " One of the more i n t r i g u i n g a s p e c t s of the homemaker r o l e i s t h a t of the homemaker as the "Good S a m a r i t a n " i n her r e l a t i o n s h i p w i t h the c l i e n t . The i n t e r v i e w s conducted w i t h the homemaker s u p e r v i s o r s and the v a r i o u s n o t a t i o n s t h a t appear on sample c l i e n t f i l e s appear t o a f f i r m t h i s phenomena as o c c u r r i n g w i t h some r e g u l a r i t y . The P o s i t i o n Paper of the V.C.C. Homemaker Program i n i t s response t o the P e r s o n a l A s s i s t a n c e G u i d e l i n e s of the homemaker a g e n c i e s w i t h i n B.C. a l s o c o n t a i n s r e f e r e n c e s t h a t can be c o n s t r u e d as b e i n g r e l a t e d t o t h i s h e l p i n g mode of the homemaker. In the m a j o r i t y of the two hundred c l i e n t case f i l e s t h a t were read f o r the purpose of data a n a l y s i s i n t h i s s t u d y , the homemaker appeared t o be p e r f o r m i n g s e r v i c e s f o r the c l i e n t t h a t c o u l d be d e s c r i b e d as housekeeping d u t i e s . For example, i n the agency f i l e s she would f r e q u e n t l y be d e s c r i b e d as b e i n g i n v o l v e d i n : " h e l p i n g Mrs. do the weekly s h o p p i n g " ; "may need t o a l s o p r e pare a l i g h t l u n c h on some days". The a r e a s i n which t h e r e appears t o be a problem f o r the homemaker, the homemaker agency, the V.C.C. homemaker program t r a i n i n g d i v i s i o n , and o t h e r concerned homemaker-oriented b o d i e s appear t o f o l l o w w i t h some p r e c i s i o n the ex a c t o u t l i n e of d i s c r e p a n c y t h a t were found i n t he Provus a n a l y s i s . These area s of co n c e r n f a l l i n t o a br o a d c a t e g o r y t h a t c o u l d be r e f e r r e d as s p e c i a l h e a l t h c a r e a s s i s t a n c e and a r e the p r a c t i c e c a t e g o r i e s o f : m o n i t o r i n g the s t a t e of h e a l t h of the c l i e n t ; a s s i s t i n g the c l i e n t w i t h m e d i c a t i o n ; and r e p l a c i n g Home Care n u r s e s on a temporary b a s i s . These same p r a c t i c e a r e a s a l s o c o n s t i t u t e s e r v i c e c a t e g o r i e s i n 69 which the homemaker may be i n v o l v e d w i t h the c l i e n t i n a s i t u a t i o n where the "Good S a m a r i t a n " p r i n c i p l e i s o p e r a t i v e . T h i s p a r t i c u l a r s i t u a t i o n and the concerns c r e a t e d by thes e homemaker p r a c t i c e s are found t o be an o f t e n r e p e a t e d theme i n the i n t e r v i e w s w i t h the s u p e r v i s o r s of the homemakers of t h i s agency. For example, one of the s u p e r v i s o r s i n her comments r e g a r d i n g the r o l e of the homemaker r e p l i e d : " . . . sometimes homemakers a r e i n v o l v e d i n b a s i c n u r s i n g a r e a s ( t h a t ) she sh o u l d n ' t be i n . . . . s h e doesn't have n u r s i n g t r a i n i n g . Sometimes she has t o tak e over f o r the Home Care Nurse because t h e r e a r e n ' t enough of these n u r s e s t o go around. Problems a r i s e i n a c r i s i s i n c e r t a i n s i t u a t i o n s . They (the homemakers) are the o n l y p e o p l e who can h e l p . " Another s u p e r v i s o r summarized the r o l e as b e i n g : " . . . . i n c e r t a i n s i t u a t i o n s the homemaker t a k e s over because t h e r e ' s no one e l s e t h e r e t o do i t . . . . " . And another s u p e r v i s o r v o i c e d c o n c e r n over the g i v i n g of m e d i c a t i o n s : "....the homemaker s h o u l d n ' t be d o i n g t h i s . . . w e need more Home Care n u r s e s . " The theme of the homemaker as the Good Sa m a r i t a n and the conc e r n s r a i s e d about t h i s r o l e a r e s u c c i n c t l y d e l i n e a t e d i n the V.C.C. p o s i t i o n paper r e g a r d i n g the p e r s o n a l a s s i s t a n c e g u i d e l i n e s of homemaker a g e n c i e s (June, 1980). T h i s paper s t a t e s : "The h i s t o r y of homemaking i n B r i t i s h Columbia tends t o g i v e r i s e t o a view of the homemaker as a k i n d l y mother s u r r o g a t e or f a m i l y f r i e n d . These k i n d s of a t t r i b u t e s a r e commendable i n the performance of some homemaking t a s k s , but i t must be c l e a r l y u n d e r s t o o d t h a t i n the eyes of the law the homemaker does not have the freedom t o p e r f o r m many a c t s which a 70 f a m i l y member c o u l d do w i t h i m p u n i t y . " In terms of the contemporary r o l e of the homemaker and the f a r r e a c h i n g consequences of t h i s expanding r o l e , the e x e c u t i v e d i r e c t o r of the agency r e s e a r c h e d f o r t h i s s t u d y , summed up her. f e e l i n g s i n an annual r e p o r t t o the homemaker a s s o c i a t i o n members as f o l l o w s : "The Board of D i r e c t o r s i s v e r y aware of the expanding r o l e of the homemaker i n the h e a l t h c a r e f i e l d and the i m p l i c a t i o n s of t h i s . In many cases- i t would be d i f f i c u l t t o d e f i n e the d i f f e r e n c e between a homemaker and a p r a c t i c a l n u r s e . " In many cases t h i s does ind e e d appear t o be the r o l e s i t u a t i o n of the homemaker. F u r t h e r m o r e , g i v e n the p r o b a b l e i n c r e a s i n g demands f o r c o m p l e x i t y of homecare a s s i s t a n c e , the homemaker's r o l e may c o n t i n u e i t s metamorphic development from t h a t of housekeeping t o the emerging r o l e of the h e a l t h c a r e . a s s i s t a n t i n the home. I n t e r p r e t a t i o n of Theory and P r a c t i c e of the Homemaker As p r e v i o u s l y s t a t e d , the t h r e e a r e a s of t h e o r y / p r a c t i c e d i s c r e p a n c y noted i n t h i s study i n v o l v e the homemaker's a s s i s t a n c e t o c e r t a i n c l i e n t s i n t e m p o r a r i l y r e p l a c i n g the Home Care n u r s e , a d m i n i s t e r i n g m e d i c a t i o n s , and m o n i t o r i n g h e a l t h s t a t e s . An example of the homemaker as Home Care nurse s u b s t i t u t e can be i l l u s t r a t e d by a handicapped c l i e n t w i t h e x t e n s i v e d e c u b i t u s u l c e r s who r e q u i r e d a bed b a t h . Home Care had been r e q u e s t e d , but was not a v a i l a b l e . The homemaker was not t r a i n e d t o r e p l a c e the Home Care n u r s e , but d i d so. In the second a r e a , c e r t a i n c l i e n t s ' s c h a r t s i n d i c a t e d d i f f i c u l t y w i t h 71 s e l f - a d m i n i s t r a t i o n of m e d i c a t i o n , and the homemaker was r e q u e s t e d t o a s s i s t them. In the a r e a of m o n i t o r i n g h e a l t h s t a t e s a t y p i c a l example was t h a t of a c l i e n t w i t h c a r d i o v a s c u l a r problems who r e q u i r e d m o n i t o r i n g of p u l s e r a t e r e l a t e d t o m e d i c a t i o n usage. These t h r e e a r e a s of p r a c t i c e a re c l e a r l y o u t s i d e the c o n f i n e s of the f o r m a l V.C.C. homemaker program. In an attempt t o f u r t h e r e x p l a i n t h i s phenomena of d i s c r e p a n c y , homemaker s u p e r v i s o r i n t e r v i e w s , documents from the V.C.C. program, and the homemaker a g e n c i e s were a n a l y z e d . I n t e r v i e w s . w i t h homemaker s u p e r v i s o r s e x p l o r e d not o n l y t h e i r i n t e r p r e t a t i o n of the homemaker r o l e , but a l s o t h e i r c o ncerns about the congruence and d i s c r e p a n c y of homemaker p r a c t i c e and t h e o r y . In t h i s a r ea of t h e o r y and p r a c t i c e a m a j o r i t y of the s u p e r v i s o r s p r e f a c e d t h e i r remarks by s t a t i n g an awareness t h a t i n c e r t a i n s i t u a t i o n s the homemaker may be p r o v i d i n g s e r v i c e s t h a t do not match the t h e o r y taught by the V.C.C. program. However, i n the s e i n s t a n c e s , the s u p e r v i s o r s f r e q u e n t l y r e f e r r e d back t o t h e i r s t a t e m e n t s r e g a r d i n g the "Good S a m a r i t a n " r o l e of the homemaker. Only one of the f o u r s u p e r v i s o r s f e l t t h a t the homemaker s h o u l d r e c e i v e f o r m a l t r a i n i n g i n the s e s p e c i f i c a r e a s of d i s c r e p a n c y . For the m a j o r i t y , the f e e l i n g was t h a t the p r e s e n t c u r r i c u l u m of the homemaker t r a i n i n g program was more than adequate and t h a t the homemaker s h o u l d a v o i d t a k i n g on the r o l e of a p r a c t i c a l nurse or n u r s e ' s a i d e . An ex p a n s i o n of the s e r v i c e and c l i e n t use of the Home Care nurse was seen as b e i n g the s o l u t i o n t o the problem of homemaker p r a c t i c e t h a t a t t i m e s may be n u r s i n g 72 r a t h e r than housekeeping. Other groups have a l s o d i s p l a y e d concerns about the p r a c t i c e / t h e o r y d i s c r e p a n c y t h a t e x i s t s i n c e r t a i n a r e a s of homemaker s e r v i c e . One of the c e n t r a l groups v o i c i n g i t s concerns i s the community c o l l e g e i n which the homemaker program was d e v e l o p e d . As was the case w i t h the r o l e of the homemaker, the p o s i t i o n paper of t h i s i n s t i t u t i o n r e g a r d i n g the p e r s o n a l a s s i s t a n c e g u i d e l i n e s f o r the homemaker o u t l i n e d some r a t h e r d e t a i l e d c o n c e r n s r e g a r d i n g t h i s s i t u a t i o n . One of the more c r i t i c a l a r e a s of concern i n v o l v e s t h a t of the homemaker's a s s i s t i n g the c l i e n t w i t h m e d i c a t i o n s . The V.C.C. p o s i t i o n paper c l e a r l y s t a t e s t h a t : "The homemaker s h o u l d not a d m i n i s t e r m e d i c a t i o n s i n any c i r c u m s t a n c e s . " (V.C.C. P o s i t i o n Paper, page 6 ) . T h i s paper goes on t o s t a t e t h a t : " I t appears t h a t homemaker a g e n c i e s a r e a t t e m p t i n g t o respond t o meet c l i e n t needs f o r m e d i c a t i o n t r e a t m e n t i n the c u r r e n t system which does not p r o v i d e adequate s u p e r v i s i o n by a p p r o p r i a t e n u r s i n g p r o f e s s i o n a l s . The answer i s not t o p r o v i d e s e r v i c e by p u t t i n g the homemaker i n l e g a l j e o p a r d y . " (V.C.C. P o s i t i o n Paper, page 7 ) . T h i s p o s i t i o n of the homemaker program o f f i c i a l s does not appear t o concur w i t h the Community Homemaker S e r v i c e s A s s o c i a t i o n of B r i t i s h Columbia G u i d e l i n e s t h a t were d r a f t e d i n 1979, and i n use i n 1980, i n which on page 2 the f o l l o w i n g g u i d e l i n e s a r e g i v e n c o n c e r n i n g m e d i c a t i o n a d m i n i s t r a t i o n : " M e d i c a t i o n i s never t o be a d m i n i s t e r e d by the homemaker u n t i l such time as she has r e c e i v e d a u t h o r i z a t i o n t o do so from her s u p e r v i s o r . . . . O n l y o r a l m e d i c a t i o n may be g i v e n by a homemaker, and i f t h e r e i s any o t h e r p o s s i b l e o p t i o n f o r 73 the a d m i n i s t r a t i o n of m e d i c a t i o n , the homemaker s h o u l d not be i n v o l v e d . " Here a g a i n , the "Good S a m a r i t a n " p r i n c i p l e appears to be o p e r a t i o n a l even w i t h i n these g u i d e l i n e s . P u r s u i n g t h i s a r e a of d i s c r e p a n c y i n t o the s p e c i f i c agency b e i n g i n v e s t i g a t e d , concerns over homemaker involvement i n c e r t a i n a r e a s of p e r s o n a l c a r e a s s i s t a n c e s u r f a c e d many t i m e s d u r i n g 1980. T y p i c a l of these d i s c u s s i o n s was a Board of D i r e c t o r s meeting of June 1980 i n which c e r t a i n board members had e x p r e s s e d t h e i r c oncerns r e g a r d i n g the l e g a l i m p l i c a t i o n s of homemakers b e i n g i n v o l v e d w i t h the a d m i n i s t r a t i o n of m e d i c a t i o n to the c l i e n t . These minutes a l s o r e f l e c t a concern f e l t by the Board about the need f o r c l a r i f i c a t i o n by the p r o v i n c i a l government as t o who sh o u l d a u t h o r i z e or take r e s p o n s i b i l i t y f o r such a c r i t i c a l s e r v i c e t o the c l i e n t . Four months l a t e r , the Board minutes of October 14 r e v e a l t h a t the agency's e x e c u t i v e d i r e c t o r had been a p p o i n t e d t o an i n t e r d i s c i p l i n a r y committee f o r the purpose of s t u d y i n g the on-go i n g problem of p e r s o n a l c a r e a s s i s t a n c e by the homemaker. One month l a t e r , a memo t o Board members on November 7 d i s p l a y s f u r t h e r c o n c e r n s w i t h t h i s a r e a of p r a c t i c e . R e f e r r i n g t o the 1978 G u i d e l i n e s i s s u e d by the M i n i s t r y of H e a l t h , the agency's d i r e c t o r e x p r e s s e d concern about the a m b i g u i t y and l a c k of d i r e c t i o n w i t h i n the area of p e r s o n a l c a r e . The memo d i s c u s s e d a t l e n g t h the M i n i s t r y G u i d e l i n e s t h a t l i s t e d a c t i v i t i e s the homemaker c o u l d p r o v i d e when c e r t a i n c o n d i t i o n s had been met. For example, c e r t a i n d u t i e s c o u l d be c a r r i e d out "when the Homemaker Agency S u p e r v i s o r i s a s s u r e d t h a t the homemaker has adequate s k i l l s and t r a i n i n g t o p e r f o r m the t a s k s 74 r e q u i r e d t o meet the i n d i v i d u a l needs of the c l i e n t . (Note t h e r e are no g u i d e l i n e s as t o 'adequate t r a i n i n g ' ) . " And on the matter of m e d i c a t i o n s p e c i f i c a l l y , t h i s same Board memo ex p r e s s e s c o n c e r n about the f a c t t h a t : "The second s e c t i o n of the G u i d e l i n e s i s p r e f a c e d w i t h : ' A s s i s t a n c e w i t h t h e f o l l o w i n g p e r s o n a l f u n c t i o n s can be undertaken i f a p p r o p r i a t e and o n l y a f t e r i n d i v i d u a l i n s t r u c t i o n and d i r e c t i o n from an a p p r o p r i a t e p r o f e s s i o n a l i n v o l v e d w i t h the i n d i v i d u a l r e c e i v i n g c a r e ' ( N o t e : There i s no d e f i n i t i o n of ' a p p r o p r i a t e p r o f e s s i o n a l ' ) . The l i s t of a c t i v i t i e s i n c l u d e : A s s i s t a n c e w i t h o r a l m e d i c a t i o n i f homemaker has been g i v e n w r i t t e n o r d e r . . . . " . The o v e r a l l a rea of p e r s o n a l c a r e a s s i s t a n c e t o the c l i e n t appeared t o c r e a t e on-g o i n g problems f o r the agency and i t s homemakers. C o n c l u s i o n s I t would appear t h a t the homemaker, the a g e n c i e s , the t r a i n i n g programs, the M i n i s t r y of H e a l t h t h a t p u r c h a s e s homemaker s e r v i c e s , and l a s t , but not l e a s t , the homemaker c l i e n t s t h emselves are p l a c e d w i t h i n an e n i g m a t i c s i t u a t i o n . There i s no s i m p l e , c l e a r c u t s o l u t i o n t o the problem t h a t now e x i s t s . V i e w i n g t h i s complex s i t u a t i o n of the homemaker's r o l e , t h e o r y , and p r a c t i c e from a Berger and Luckman p o i n t of v i e w , the ownership of knowledge r e l a t e d e s p e c i a l l y t o t h e a r e a of p e r s o n a l c a r e a s s i s t a n c e , and a l s o the c o r r e s p o n d i n g c o n t r o l of t h a t knowledge, appears t o not be c l e a r l y e s t a b l i s h e d f o r a l l p a r t i e s c o n c erned (Berger and Luckman,1966). 75 A t t h e same t i m e , w i t h t h e d i s p e r s e m e n t o f h e a l t h a n d s o c i a l s e r v i c e a s s i s t a n c e t o c l i e n t s i n home s e t t i n g s a n d away f r o m t h e m o r e r i g i d l y c o n t r o l l e d , i n s t i t u t i o n a l s e t t i n g s , s u c h a s h o s p i t a l s , t h e r e may h a v e o c c u r r e d a c o r r e s p o n d i n g l o o s e n i n g o f p r e v i o u s , a r e a s o f k n o w l e d g e a n d p r a c t i c e c o n t r o l . T h a t i s t o s a y t h a t t h e n u r s e ' s a i d e , f o r e x a m p l e , w i t h i n m o s t h o s p i t a l s e t t i n g s a p p e a r s t o h a v e a r a t h e r w e l l d e f i n e d r o l e . I n m o s t h o s p i t a l s e t t i n g s t h e r e i s a w e l l d e f i n e d a n d c o n c i s e l y e x e c u t e d c o n t r o l o v e r t h e t r a i n i n g p r o g r a m a n d t h e c o r r e s p o n d i n g p r a c t i c e t h a t t h i s i n d i v i d u a l i s e x p e c t e d t o p e r f o r m w i t h i n t h e i n s t i t u t i o n . F o r t h e h o m e m a k e r w i t h i n t h e r e s e a r c h m i l i e u o f t h i s s t u d y , t h e s e d e m a r k a t i o n s a n d c o n t r o l b o u n d a r i e s do n o t a p p e a r t o h a v e b e e n e s t a b l i s h e d w i t h t h e same p r e c i s i o n a s t h a t o f t h e a i d e i n i n s t i t u t i o n a l s e t t i n g s . I t w o u l d t h e n a p p e a r t h a t t h e d i s p e r s a l o f c e r t a i n c l i e n t s w i t h h e a l t h c a r e n e e d s i n t o home r a t h e r t h a n i n s t i t u t i o n a l s e t t i n g s c a r r i e s w i t h i t s p e c i f i c p r o b l e m s a s w e l l a s a d v a n t a g e s , b o t h t o t h e c l i e n t a n d t h e t a x p a y e r . I n t h e l o n g r u n i t may w e l l be t h a t t h e d e l i c a t e b a l a n c e o f h e a l t h c a r e a n d s o c i a l s e r v i c e a s s i s t a n c e , d o c u m e n t e d by M a c l n t y r e i n h e r r e v i e w o f t h e B r i t i s h s y s t e m o f t h e s e v e n t i e s , w i l l c o n t i n u e t o c r e a t e a s e n s e o f o n - g o i n g t e n s i o n b e t w e e n w h a t i s b e s t f o r t h e h o m e m a k e r c l i e n t w i t h i n t h e home s e t t i n g a s o p p o s e d t o w h a t i s b e s t f o r t h e t a x p a y e r s o f t h e p r o v i n c e . T h e t h i r d i s s u e t h a t a p p e a r s t o be i n t e r t w i n e d w i t h t h i s c o m p l e x s i t u a t i o n i s t h e p o s s i b i l i t y t h a t home c a r e a s s i s t a n c e may i n many s i t u a t i o n s n o t be t h e b e s t s o l u t i o n f o r many c l i e n t s . T h e r e a p p e a r s t o h a v e b e e n , e s p e c i a l l y d u r i n g t h e 76 s e v e n t i e s , an u n d e r s t a n d i n g t h a t home c a r e was the u l t i m a t e answer t o the problem of h e a l t h and s o c i a l s e r v i c e a s s i s t a n c e t o the c h r o n i c a l l y i l l , the e l d e r l y , and the dependent i n d i v i d u a l . W h i l e t h i s form of a s s i s t a n c e i s both c o s t b e n e f i c i a l and m e d i c a l l y e f f e c t i v e f o r some c l i e n t s , i t cannot be assumed t h a t i t i s s u i t a b l e f o r a l l . G i ven the p a u c i t y of any r e s e a r c h r e l a t e d t o the m u l t i p l i c i t y of f a c t o r s t h a t must be c o n s i d e r e d i n a s s e s s i n g t h i s form of a s s i s t a n c e , i t s widespread use must be q u e s t i o n e d . The f i n a l i s s u e t h a t appears t o be a c o n t i n u a l problem f o r those i n v o l v e d i n the homecare s e r v i c e area i s the q u e s t i o n of who i s u l t i m a t e l y i n c o n t r o l of t h i s e n t i t y we r e f e r t o as homemakers. At p r e s e n t , w i t h o u t the e x i s t a n c e of some form of l i c e n s u r e of the homemakers, t h e i r c o n t r o l b o u n d a r i e s a re v e r y i l l d e f i n e d . The l e v e l s of t r a i n i n g of the homemakers v a r y w i d e l y throughout the p r o v i n c e . Some of these homemakers have been t r a i n e d by the community c o l l e g e homemaker programs. O t h e r s have o n l y m i n i m a l on the j o b t r a i n i n g . The c l i e n t , i t app e a r s , has no as s u r a n c e of u n i f o r m i t y of t r a i n i n g . Indeed, the p r a c t i c e d i s c r e p a n c i e s t h a t appear w i t h i n t h i s c l o s e l y d e f i n e d r e s e a r c h a r e a may be much more e x t e n s i v e f o r o t h e r a g e n c i e s and t h e i r homemakers. T h i s contemporary s t a t e of d i s c r e p a n c y w i l l c o n t i n u e t o e x i s t u n t i l such time t h a t t h e r e i s some c l e a r l y e s t a b l i s h e d , u n i f o r m g u i d e l i n e s f o r a l l a g e n c i e s , a l l t r a i n i n g programs, and a l l homemakers p r a c t i c i n g i n the p r o v i n c e . 77 Recommendat i o n s Having s t u d i e d the r e s e a r c h f i n d i n g s r e l a t e d . t o the homemaker, the w r i t e r makes the f o l l o w i n g recommendations c o n c e r n i n g the o c c u p a t i o n of homemaking as i t e x i s t s w i t h i n the P r o v i n c e of B r i t i s h Columbia. 1) I t i s recommended t h a t the M i n i s t r y of H e a l t h , i n  c o n s u l t a t i o n w i t h a l l homemaker a g e n c i e s and a l l homemaker  t r a i n i n g programs throughout the p r o v i n c e , s h o u l d e s t a b l i s h  c l e a r - c u t g u i d e l i n e s f o r the r o l e and p r a c t i c e of the homemaker t h a t w i l l be u n i f o r m i n t h e i r useage by homemakers and s t r i c t l y I I -- — — e n f o r c e d t hroughout the p r o v i n c e . A d d i t i o n a l l y , t h a t the M i n i s t r y of H e a l t h i n the P r o v i n c e of B r i t i s h Columbia s h o u l d assume the u l t i m a t e l e g a l l i a b i l i t y i n the a r e a of homemaker p r a c t i c e . F i n a l l y , w i t h i n t h i s a r e a of homemaker p r a c t i c e t h e r e s h o u l d be v e r y c l o s e s u p e r v i s i o n of a g e n c i e s and homemakers f o r the purpose of a s s u r i n g o p t i m a l , s a f e l e v e l s of s e r v i c e t o a l l c l i e n t s . 2) I t i s recommended t h a t a p r o c e s s of l i c e n s i n g the  homemaker be i n s t i t u t e d . T h i s a c t of l i c e n s i n g homemakers throughout the p r o v i n c e would s e r v e t o a s s u r e the c l i e n t t h a t a homemaker, employed by any g i v e n agency w i t h i n the p r o v i n c e , would i n f a c t have r e c e i v e d adequate homemaker t r a i n i n g and would p o s s e s s the proper q u a l i f i c a t i o n s needed t o meet s p e c i f i c c l i e n t needs. 3) In the a r e a of t r a i n i n g , i t i s recommended t h a t the  p r o v i n c i a l and/or the f e d e r a l government p r o v i d e adequate  e d u c a t i o n a l f u n d i n g a s s i s t a n c e f o r homemakers a l r e a d y p r a c t i c i n g  who have not r e c e i v e d f o r m a l t r a i n i n g i n homemaking. 7 8 F u r t h e r m o r e , t h e s e homemakers s h o u l d be encouraged t o upgrade t h e i r t r a i n i n g l e v e l s by s u s t a i n e d s u p p o r t and encouragement of not o n l y t h e i r agency employers but a l s o by the p r o v i n c i a l government t h a t i s the u l t i m a t e p u r c h a s e r of t h e i r s e r v i c e . 4) I t i s a l s o recommended t h a t the community c o l l e g e s  c u r r e n t l y i n v o l v e d i n the t r a i n i n g of homemakers expand t h e i r  e d u c a t i o n a l e x p e r t i s e t o make a v a i l a b l e i n - s e r v i c e programs f o r  a l l homemaker a g e n c i e s w i t h i n the p r o v i n c e . 5) The f i n a l recommendation i s t h a t t h e r e be expanded and  a c c e l e r a t e d r e s e a r c h w i t h i n the broad area of homemaker  c o n c e r n s . G i v e n the r a p i d l y c hanging dimensions of the homemaker's r o l e and p r a c t i c e , i t i s i m p e r a t i v e t h a t d e c i s i o n s r e l a t e d t o these a r e a s , and indeed t o the whole of homemaking as an o c c u p a t i o n a l e n t i t y , be a s s i s t e d by means of on-going r e s e a r c h and development. 79 R e f e r e n c e s Research A r t i c l e s and Books B e r g e r , P e t e r L. and Luckman, Thomas. The S o c i a l C o n s t r u c t i o n  of R e a l i t y . Garden C i t y , New.York: Doubleday and Company, 1 966. H o l s t i , O l e . Content A n a l y s i s f o r the S o c i a l S c i e n c e s and H u m a n i t i e s . Don M i l l s , O n t a r i o : Addison-Wesley P u b l i s h i n g Company, 1969. L e w i s , D.J., and Scheuren, M.T.. Home H e a l t h Management  A s s i s t a n t : R e p o r t , 1975. ERIC Document R e p r o d u c t i o n S e r v i c e No. ED.122079. M a c l n t y r e , S a l l y . "Old Age As A S o c i a l Problem", i n R. D i n g w a l l ( E d . ) , H e a l t h Care and H e a l t h Knowledge. London: Croom Helm, L t d . , 1977. Pr o v u s , Malcolm. D i s c r e p a n c y E v a l u a t i o n . B e r k e l e y : McCutchan P u b l i c a t i o n C o r p o r a t i o n , 1971. Rhodes, P h i l i p . The V a l u e of M e d i c i n e . C h i c a g o : George A l l e n and Unwin L t d . , 1976. R i p p l e , H e l e n . S u p e r v i s i o n of the P a r a p r o f e s s i o n a l , 1973. ERIC Document R e p r o d u c t i o n S e r v i c e No. ED. 087528. Ro b i n s o n , Nancy. C o s t s of Homemaker-Home H e a l t h A i d e , 1974. ERIC Document R e p r o d u c t i o n S e r v i c e No. ED. 107879. S h i p l e y , Anna. A n a l y s i s of Tasks i n Three Home R e l a t e d O c c u p a t i o n s , 1967. ERIC Document R e p r o d u c t i o n S e r v i c e No. ED. 026484. Webb, E.J.,.and Campbell, D.T., Sch w a r t z , R.D., and S e c h e r t , L. U n o b t r u s i v e Measures: n o n r e a c t i v e r e s e a r c h i n the s o c i a l  s c i e n c e s . C h i c a g o : Rand-McNally, 1966. Webb, E . J . , and S a l a n c i k , J.R. "Notes on the S o c i o l o g y of Knowledge." J o u r n a l i s m Q u a r t e r l y , 1965. 80 Survey R e p o r t s Report on Homemakers and R e l a t e d S e r v i c e s i n G r e a t e r Vancouver.. Mary M e r c e r , c o - o r d i n a t o r . P r e p a r e d by the G r e a t e r Vancouver S o c i e t y f o r C o - o r d i n a t i n g Home S e r v i c e s , Vancouver, November, 1974. Homemaker S e r v i c e For E l d e r l y P e rsons i n B.C. P r e p a r e d by the Committee on A g i n g , S o c i a l P l a n n i n g , and Review C o u n c i l of B r i t i s h Columbia, 4 A p r i l , 1977. V i s i t i n g Homemaker S e r v i c e s i n Canada: Report of A Survey w i t h  Recommendations. P r e p a r e d by the A d v i s o r y Committee on V i s i t i n g Homemaker S e r v i c e s , The Canadian C o u n c i l on S o c i a l Development, Ottawa, March, 1971. P r i m a r y and Secondary Source Documents Vancouver Sun, 14 February., 1973. P r o v i n c e ( V a n c o u v e r ) , 5 J a n u a r y , 1978. C o l o n i s t ( V i c t o r i a ), 11 June, 1979. Development of the Vancouver C i t y C o l l e g e Homemaker Program,  Report of Phase I I I , Document p u b l i s h e d by Vancouver Community C o l l e g e , K i n g Edward Campus, June, 1978. I n t r o d u c t i o n t o the Program of Long Term Ca r e, Document p u b l i s h e d by the B r i t i s h Columbia M i n i s t r y of H e a l t h , J a n u a r y , 1978. M i n u t e s from the Board of D i r e c t o r s ' M e e t i n g s , Agency r e s e a r c h e d : 1938; June, 1980; O c t o b e r , 1980; November, 1980. P o s i t i o n Paper Homemaker Program P e r s o n a l A s s i s t a n c e G u i d e l i n e s P r e p a r e d by the A d v i s o r y Committee t o the Homemaker Program, Vancouver Community C o l l e g e , K i n g Edward Campus, June, 1980. P e r s o n a l A s s i s t a n c e G u i d e l i n e s of the P r o v i n c i a l A s s o c i a t i o n of  Homemaker A g e n c i e s of B r i t i s h C o lumbia , 1979. 81 Report of the E x e c u t i v e D i r e c t o r , Agency r e s e a r c h e d , t o the Annual M e e t i n g of the Homemaker A s s o c i a t i o n , September, 1980. Undated b r o c h u r e , agency r e s e a r c h e d , c o n c e r n i n g d e s c r i p t i o n of homemaker s e r v i c e s . Undated i n t e r n a l communication, agency r e s e a r c h e d , r e g a r d i n g homemaker t r a i n i n g . Vancouver Community C o l l e g e Homemaker P r o g r a m - A l t e r n a t i v e 1, Document i s s u e d by Vancouver Community C o l l e g e , 1980. 82 Appendix The f o l l o w i n g m a t e r i a l i s p r o v i d e d as a example of how the c o n t e n t a n a l y s i s c o d i n g was performed on the c l i e n t f i l e s . I n c l u d e d i s an a c t u a l c l i e n t f i l e t h a t was chosen from a c u r r e n t 1981 c l i e n t l i s t . A l l c o n f i d e n t i a l m a t e r i a l and i d e n t i f y i n g c h a r a c t e r i s t i c s have been removed f o r the purpose of a s s u r i n g c o n f i d e n t i a l i t y t o the c l i e n t , the agency, and a l l o t h e r p a r t i e s i n v o l v e d . Content A n a l y s i s . o f a C l i e n t F i l e R e l a t e d t o C a t e g o r i e s  Researched W i t h i n T h i s T h e s i s Age : 81 (husband) 76 ( w i f e ) . Sex : Male and Female ( C o u p l e ) . Number i n F a m i l y U n i t : 2. Area of Residence : 18. R e f e r r a l Mode : M e d i c a l S t a f f . C l i e n t D i a g n o s i s Catagory : M e d i c a l Problems. Homemaker P r a c t i c e C a t e g o r i e s : C l e a n i n g , Laundry, Meal P r e p a r a t i o n = Combined Housekeeping. Provus E v a l u a t i o n C a t e g o r i e s = 8.0 C l e a n ; 9.0 Do Laundry, and 10.0 Prepar e M e a l s . ENQUIRY FOR HOMEMAKER SERVICE 8 3 D A T E . </A/x / / C L I t . . f ' S / j R N A M E H U S B A N D B I R T H D A Y W ' F E , ^ B I R T H D A Y * . • H O M E PHONE:*. . BUS. P H O N E : 1 A D D R E S S Single ( ) Married KiA Sep. ( ) Wid. ( ) Div. • ' ( " ) C H I L D R E N : N A M E B I R T H D A T E S C H O O L 1 : : 2 ;  3 : 4 . : 5 6 Others in the home: _ _ RES/NON-RES. CP <^ 1 J * _ E D H O U R S O F W O R K ' D A Y S O F W O R K D U R A T I O N ? D A T E S E R V I C E R E Q U I R D O C T O R P H O N E N o . S P E C I A L I S T P H O N E N o . R E F E R R E D BY: - ' ) R E A S O N S F O R S E R V I C E : -Us-tjj. CC^ 0C\i>>^j>iA ( / r j n ^ v w - v - / K - ^ J - b'pA^jL 

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